Metabolic  Rate 
Determinations 


BOOTHBY  -  SAUDI  FORD 


UNIVERSITY  OF  CALIFORNIA 

MEDICAL  CENTER  LIBRARY 

SAN  FRANCISCO 


FROM  THE  LIBRARY  OF 
HERBERT  C.  MOFFITT,  SR, 


Laboratory  Manual 

of  the  Technic  of 

Basal  Metabolic  Rate 

Determinations 


By 

Walter  M.^Boothby,  A.  M.,  M.  D. 

and 

Irene  Sandiford,  Ph.  D. 

Section  on  Clinical  Metabolism 
The  Mayo  Clinic,  Rochester,  Minnesota 

and 
The  Mayo  Foundation,  University  of  Minnesota 


Illustrated 


Philadelphia  and  London 

W    B.  Saunders  Company 

1920 


Copyright,  ig2o,  by  W.  B.  Saunders  Company 


PRINTED     IN    AMERICA 

PRESS    OF 

B.     SAUNDERS     COMPANY 
PHILADELPHIA 


B72.L 
1924 


TO 

J.  S.  H. 

H.  C. 

H.  S.  P. 


PREFACE 

NEW  methods  of  precision  for  the  study  of  disease  are  con- 
tinuously passing  from  the  purely  scientific  to  the  more  prac- 
tical clinical  application.  The  most  recent  of  these  methods  of 
precision  and  probably  the  most  difficult  technically  is  indirect 
calorimetry.  This  manual  has  been  prepared  in  the  effort  to 
render  this  valuable  diagnostic  method  available  to  any  well- 
equipped  and  scientifically  conducted  clinical  aboratory,  and  with 
the  hope  that  the  results  of  indirect  calorimetry  will  not  be 
thrown  into  general  discredit  by  a  neglect  of  the  details  requisite 
for  obtaining  a  true  basal  metabolic  rate. 


ROCHESTER,  MINNESOTA. 
August,  1920. 


CONTENTS 


SECTION   I 

GENERAL  DISCUSSION 11 

Basal  Metabolic  Rate 11 

Normal  Standards 14 

Clinical  Calorimetry 17 

Direct  and  Indirect  Calorimetry.     The  Respiration  Calorimeter 18 

Agreement  of  Direct  and  Indirect  Calorimetry 20 

Indirect  Calorimetry 20 

Unit  Apparatus 20 

Portable  Unit  Apparatus 21 

Gasometer 22 

SECTION   II 

DETAILS  OF  TECHNIC 24 

THE  PATIENT 24 

Postabsorptive  Condition 24 

Muscular  Activity ' 24 

Preliminary  Rest  Period 25 

Effect  of  Body  Temperature 29 

Character  of  Respiration 30 

Effect  of  Sleep 30 

Body  Position 31 

Observer's  Chart 32 

Repetition  of  Test 34 

THE  GASOMETER  AND  ACCESSORY  APPARATUS 35 

Mask 35 

Valves 37 

Intake  Pipe 41 

Outdoor  Air 41 

Room  Air 41 

Connections 42 

Gasometer 42 

Barometer 49 

Calibration  of  Gasometer 49 

Collection  of  Expired  Air  in  Gasometer 50 

Sampling  Tubes 52 

Stratification  of  Air  in  Gasometer 53 

Effect  on  the  Carbon  Dioxid  and  Oxygen  Content  of  the  Expired  Air 

from  Standing  in  the  Gasometer 55 

7 


8  CONTENTS 


I'AGK 


THE  HALDANE  GAS  ANALYSIS  APPARATUS 56 

Description  of  Haldane  Apparatus 56 

Calibration  of  Haldane  Buret 60 

Assembling  the  Haldane 65 

Electric  Glass  Cutter 66 

Control  Tube 68 

Management  of  Haldane  Apparatus 68 

Preliminary 68 

Sampling 70 

Analysis 72 

Care  of  Haldane 73 

Filling  Haldane 77 

Analysis  of  Outdoor  Air 78 

Shaker 79 

SOLUTIONS 80 

Potassium  Pyrogallate  Solution  (Haldane) 80 

Potash  Solution  for  Carbon  Dioxid  Absorption 80 

Black  Rubber  Grease 81 

Cleaning  Solution ...  81 

Cleaning  Mercury 81 

SECTION    III 

CALCULATION  OF  BASAL  METABOLIC  RATE 82 

Volume  of  Expired  Air 82 

Correction  of  Barometer  to  0°  C 83 

Correction  for  Water  Vapor 83 

Reduction  to  Standard  Pressure 83 

Reduction  to  Standard  Temperature 83 

Ventilation  Rate 84 

Carbon  Dioxid  Production , 84 

Oxygen  Absorption 84 

Respiratory  Quotient 85 

Calories  per  Square  Meter  per  Hour 86 

Basal  Metabolic  Rate  (B.  M.  R.) 86 

Checking  Calculations 86 

Non-protein  Respiratory  Quotient 87 

Calculation  of  Metabolic  Rate  of  a  Diabetic 88 

BIBLIOGRAPHY 89 

APPENDIX 94 

Explanation  of  Tables 94 

Table  I,  Equivalent  of  Seconds  in  Decimal  Parts  of  a  Minute 94 

Table  II,  Log  Factor  for  Reducing  Volume  of  Gases  to  Standard 

Temperature  and  Pressure,  Dry 96 


CONTENTS  9 

Table  III,  Correction  Inspired  Oxygen  Percentage  to  Basis  of  Ex- 
pired Volume 104 

Table  IV,  Calorific  Value  of  One  Liter  of  Oxygen  for  Various  Res- 
piratory Quotients 105 

Table  V,  Du  Bois  Height- weight  Chart 106 

Table  VI,  Aub  and  Du  Bois  Normal  Standards 107 

Table  VII,  Four-place  Logarithms 108 

Form  1,  Observer's  Chart facing  page  1 12 

Form  2,  Calculation  Sheet facing  page  112 

Form  3,  Summary  Card facing  page  112 

Form  4,  Outdoor  Air  Analysis facing  page  112 

INDEX..  .   113 


TECHNIC    OF    BASAL    METABOLIC 
RATE    DETERMINATIONS 


SECTION  I 
GENERAL  DISCUSSION 

1.  Basal  Metabolic  Rate. — "In  each  mammal  there  is  a  basal 
metabolism."55  By  the  term  "basal  metabolism"  or  "basal  meta- 
bolic rate"  of  an  organism  is  meant  the  minimal  heat  production 
of  that  organism,  measured  from  twelve  to  eighteen  hours  after 
the  ingestion  of  food  and  with  the  organism  at  complete  muscular 
rest.  This  minimal  heat  production  may  be  determined  directly 
by  actual  measurement  by  means  of  a  calorimeter,  or  indirectly 
by  calculating  the  heat  production  from  an  analysis  of  the  end- 
products  which  result  from  oxidation  within  the  organism,  or 
specifically  from  the  amount  of  oxygen  used  and  the  corresponding 
amount  of  carbon  dioxid  produced,  together  with  the  total  nitrogen 
eliminated  in  the  urine. 

The  physiologic  importance  of  oxygen  for  the  needs  of  the  body 
was  recognized  by  Lavoisier  (1780),  who  identified  and  named  the 
gas.  It  is  remarkable  how  clear  was  his  conception  of  the  problem 
of  animal  combustion  both  qualitatively  and  quantitatively.  He 
determined  the  oxygen  requirement  with  the  subject  fasting  both 
at  rest  and  at  work,  and  also  carried  on  experiments  on  the  effect 
of  food  ingestion,  showing  that  the  oxidative  processes  within  the 
body  were  thereby  increased. 

It  was  not  until  1850  that  serious  attempts  were  made  to  ad- 
vance the  work  of  Lavoisier.  At  this  time  Regnault  and  Reiset 

ii 


12  BASAL   METABOLIC   RATE 

devised  an  apparatus  for  the  measurement  of  the  respiratory  ex- 
change, that  is,  the  amount  of  oxygen  absorbed  by  the  subject  and 
the  simultaneous  determination  of  the  carbon  dioxid  produced.  The 
apparatus  was  of  the  closed-circuit  type,  in  which  the  subject  re- 
breathed  air  from  a  closed  system  from  which  the  carbon  dioxid 
produced  was  removed  by  absorption  in  potash  solution  and  the 
oxygen  consumed  was  replaced  as  it  was  used  by  a  known  amount 
of  oxygen. 

A  respiration  apparatus  which  measured  only  the  amount  of 
carbon  dioxid  produced  was  constructed  by  Pettenkofer  in  1862, 
under  Carl  Voit's  direction.  The  latter,  using  the  heat  values  de- 
termined in  his  laboratory  by  Rubner  for  protein,  fat,  and  carbo- 
hydrate, calculated  the  quantity  of  heat  arising  from  the  burning 
of  these  substances  within  the  body,  thus  developing  the  method  of 
indirect  calorimetry. 

Rubner  in  1894  constructed  the  first  successful  respiration 
calorimeter  for  experimental  work  on  dogs.  In  connection  with 
the  calorimeter  he  used  the  respiration  apparatus  of  Pettenkofer 
and  Voit,  and  so  was  able  to  show  the  agreement  between  the 
methods  of  direct  and  indirect  calorimetry,  and  to  prove  that  the 
law  of  conservation  of  energy  holds  for  the  living  organism. 

In  1894  the  United  States  Government  began  a  series  of  inves- 
tigations on  problems  of  nutrition.  Funds  were  granted  by  our 
government  to  Professor  Atwater,  of  Wesleyan  University,  who 
had  been  associated  with  Voit  for  a  number  of  years,  and  in  1897 
an  account  of  the  Atwater-Rosa  respiration  calorimeter  was  pub- 
lished. The  respiration  apparatus  of  Pettenkofer  and  Voit  was  used 
in  connection  with  the  calorimeter,  so  that  it  was  possible  to  de- 
termine on  man  the  carbon  dioxid  production  together  with  the 
actual  heat  elimination. 

Later  the  Carnegie  Institute  granted  a  fund  to  Atwater  for  the 
perfection  of  the  apparatus,  and  in  1905  the  Atwater-Benedict 


BASAL    METABOLIC    RATE  13 

respiration  calorimeter  for  the  simultaneous  determination  of  the 
heat  elimination,  carbon  dioxid  production,  and  oxygen  absorp- 
tion of  a  subject  was  completed.  The  accurate  measurement  of 
the  oxygen  absorption  was  an  important  improvement,  for  it  was 
now  possible  to  apportion  accurately  the  quantity  of  oxygen  used 
for  the  combustion  of  protein,  fat,  and  carbohydrate  if,  in  addition, 
the  urinary  nitrogen  were  determined. 

As  a  result  of  another  generous  grant  of  funds  from  the  Carnegie 
Institute  the  Carnegie  Nutrition  Laboratory  was  built  in  Boston, 
and  Professor  Francis  G.  Benedict,  then  of  Wesleyan  University, 
was  placed  in  charge.  Under  his  direction  careful  investigations 
have  been  made  of  the  accuracy  of  the  various  types  of  respiration 
apparatus,14' 29  and  the  respiration  calorimeter  was  improved  still 
further.  Moreover,  many  fundamental  problems  in  nutrition  have 
been  worked  out  in  this  laboratory  in  the  greatest  detail  and  with 
the  highest  degree  of  accuracy.  The  studies  on  prolonged  fasting11 
and  on  restricted  diet,21  the  investigations  on  the  metabolism  of 
normal  persons,15' 19  of  infants,25  and  of  diabetics20  are  particularly 
valuable. 

Professor  Graham  Lusk,  with  the  aid  of  Dr.  H.  B.  Williams, 
in  1912  constructed  a  small  respiration  calorimeter  at  Cornell 
Medical  College  for  the  investigation  on  dogs  (and  on  infants)  of 
various  metabolic  problems.  The  results  of  this  work  were  pub- 
lished by  Lusk  and  his  co-workers  in  a  series  of  papers  on  Animal 
Calorimetry.53  This  great  contribution  by  Lusk  has  done  much  to 
clear  up  many  fundamental  problems  and  to  stimulate  and  direct 
along  definite  lines  further  researches  on  metabolism. 

Lusk  and  Du  Bois  and  their  co-workers  in  1915  began  the  publi- 
cation of  a  series  of  papers  on  Clinical  Calorimetry,54  having  con- 
structed, through  funds  from  the  Russell  Sage  Institute  of  Path- 
ology, a  respiration  calorimeter  at  Belle vue  Hospital,  New  York, 
with  Dr.  Eugene  Du  Bois  as  medical  director.67  In  these  papers 


14  BASAL    METABOLIC    RATE 

they  showed  definitely  the  close  agreement  between  direct  and  in- 
direct calorimetry  in  the  normal  as  well  as  in  all  the  pathologic 
conditions  investigated  by  them. 

2.  Normal  Standards. — A  very  important  contribution  was 
made  by  Du  Bois  in  determining  the  heat  production  in  normal  con- 
trols. Rubner69  had  suggested  that  the  heat  production  of  an  in- 
dividual was  proportional  to  his  surface  area.  For  the  determina- 
tion of  the  surface  area  Meeh  proposed  the  formula : 

Surface  area  (sq.  cm.)   =  12.3  (a  constant)  X  weight  (gm.)5 

However,  using  the  surface  area  obtained  by  this  formula  as  a  basis 
of  comparison,  the  heat  production  of  normal  controls  still  showed 
quite  wide  variations,  although  not  as  great  as  when  compared  on 
the  basis  of  weight  alone.  By  exact  measurements  of  the  surface 
area  of  several  bodies  Du  Bois  demonstrated  an  error  in  the  above 
formula  due  in  greater  part  to  the  fact  that  the  height  of  the  sub- 
ject was  neglected.34' 40  As  a  result  of  further  studies  Eugene  F. 
Du  Bois  and  Delafield  Du  Bois35' 70  devised  a  formula  based  on  height 
and  weight  by  means  of  which  the  surface  area  can  be  calculated 
with  an  average  error  of  1.7  per  cent.  This  formula  is 
A  =  W°-425  X  HO-725  X  71.84 

where  A  is  the  surface  area  in  square  centimeters,  W  is  the  weight  in 
kilograms,  and  H  is  the  height  in  centimeters,  and  71.84  is  a  con- 
stant. On  the  basis  of  this  formula  they34  then  constructed  a  height- 
weight  chart  by  means  of  which  the  surface  area  can  be  estimated 
at  a  glance.  Du  Bois,  using  this  new  height-weight  chart  for  the 
determination  of  the  surface  area  in  conjunction  with  his  standards 
of  normal  basal  metabolism  for  age  and  sex,4' 36>  40' 63  further  showed 
that  the  metabolism  of  normal  persons  could  be  predicted  with 
an  accuracy  of  =*=  10  per  cent.  This  fact  has  been  confirmed  both 
by  Means  and  by  Boothby. 
Benedict  has  severely  criticized  the  method  of  predicting  the  heat 


NORMAL    STANDARDS 


production  from  the  unit  of  surface  area,  maintaining  uthat  the 
metabolism  or  heat  output  of  the  human  body  even  at  rest  does 
not  depend  on  Newton's  law  of  cooling  and,  therefore,  is  not  pro- 
portional to  the  body  surface."8  Harris  and  Benedict  in  a  very 
exhaustive  treatise  have  reconsidered  the  entire  problem  of  the  pre- 
diction of  the  normal  basal  metabolic  rate,  and  show  that  by  proper 
biometric  formulas,  based  on  stature,  body  weight,  sex,  and  age  (the 
same  factors  as  used  by  Du  Bois),  "results  as  good  as  or  better  than 
those  obtainable  from  the  constant  of  basal  metabolism  per  square 
meter  of  body  surface  can  be  obtained  by  biometric  formulas  in- 
volving no  assumption  concerning  the  derivation  of  surface  area, 
but  based  on  direct  physical  measurements."  Since  their  publica- 
tion we  have  not  had  time  to  study  in  detail  the  accuracy  of  the  two 
methods  of  prediction.  We  have,  however,  tabulated  404  deter- 
minations of  the  basal  metabolic  rate  expressed  in  percentages 
above  and  below  normal,  using  both  the  standards  of  Du  Bois  and 
of  Harris  and  Benedict.  The  average  rates  of  all  the  cases  show 
that  the  rates  obtained  by  Harris  and  Benedict's  method  are  6.5 
points  higher  than  those  obtained  by  Du  Bois'  method.  The  par- 
allelism between  the  results  obtained  by  the  two  methods  is  strik- 
ingly shown  in  Table  1,  in  which  it  is  seen  that  195  of  the  404  de- 
terminations are  within  ="=2.5  of  the  average  variation.  Only  52 

TABLE  1.   COMPARISON  OF  METABOLIC  RATES  OBTAINED  BY 
HARRIS1    AND  BENEDICT'S  METHOD  WITH  THOSE  OBTAINED  BY  DU  BOIS1   METHOD 


Difference  between  Harris1 
and   Benedict's  rates  from 
Du  Bois'  rates  as  standard 

Number  of  determinations 
for  each  range 

-10  to  -6 
-  5  to  -1 
0  to  +3 
+  4  to  +9 
+10  to  +14 
+15  to  +19 
+20  to  +25 

3 

20 
88 
195* 
69 
24 
5 

Average  of  404  determinations  +6.5 
«within  ±2.5  of  this  average 

1 6  BASAL    METABOLIC    RATE 

of  the  entire  404  rates  deviate  more  than  7.5  from  the  average 
variation.  The  comparative  agreement,  therefore,  of  the  two 
methods  is  very  satisfactory,  indicating  as  it  does  the  similarity 
of  both  methods  of  comparison,  and  supporting  in  a  large  propor- 
tion of  the  cases  the  clinical  conclusions  based  on  the  Du  Bois 
and  Du  Bois  height-weight  chart  and  the  Du  Bois  normal  standards 
for  comparison. 

The  fact  that  the  metabolic  rate  decreases  with  progressive 
inanition,  as  in  Benedict's  thirty-day  fasting  man,  and  in  prolonged 
restricted  diet  is,  in  our  opinion,  an  argument  in  favor  of  the  clinical 
value  of  a  knowledge  of  the  heat  production.  The  conditions  cited 
by  Benedict  are  abnormal  and  the  data  presented  both  from  the 
metabolic  and  clinical  viewpoint  substantiate  observations  (not 
yet  published)  made  by  us  that  a  decrease  in  the  metabolic  rate 
occurs  in  certain  types  of  undernutrition.  Such  conditions  cannot 
be  considered  normal  either  by  the  clinician  or  the  physiologist, 
and  therefore  cannot  be  rightly  used  as  an  argument  against  the 
validity  of  a  proposed  standard  of  normality. 

Nevertheless,  Benedict's13  statement  that  "There  is  no  inflex- 
ible standard  for  normal  metabolism  for  any  given  age,  weight, 
height,  and  sex,  from  which  all  normal  individuals  never  vary," 
is  true.  It  would  also  be  true  if  applied  to  other  physiologic  data 
of  clinical  value  commonly  determined,  such  as  the  temperature,15 
the  systolic  and  diastolic  blood-pressure,  the  pulse-rate,  the  acuity 
of  hearing  and  vision,  and  the  like.  For  instance,  in  the  evalua- 
tion of  the  temperature  clinicians  are  rarely  concerned  by  variable 
readings  between  97°  and  99°  F.  Yet,  they  properly  consider  an 
elevation  above  99°  F.  as  indicative  of  febrile  disease,  usually  of  a 
bacterial  character,  in  spite  of  the  fact  that  occasionally  normal  and 
healthy  people  have  temperatures,  under  certain  conditions,  of 
over  99°  F. 

During  the  past  three  years  we  have  made  more  than  10,000 


CLINICAL    CALORIMETRY  17 

metabolic  rate  determinations  both  on  healthy  people  and  on 
patients  suffering  from  various  diseases.  Our  results  will  be  re- 
ported in  detail  elsewhere,  but  it  is  in  place  here  to  state  that  only 
occasionally  have  we  found  patients  who  had  metabolic  rates  be- 
yond the  normal  limits  established  by  Du  Bois  which  could  not  be 
accounted  for  by  the  presence  of  a  definite  pathologic  condition. 
Furthermore,  we  are  convinced  that  certain  pathologic  conditions 
always  produce  characteristic  variations  in  the  metabolic  rate  and, 
in  addition,  that  there  is  a  much  larger  group  of  diseases  in  which 
there  is  no  abnormal  variation  in  the  heat  production,  just  as  there 
are  many  diseases  which  have  a  normal  temperature.  We  con- 
sider, therefore,  that  the  metabolic  rate  differentiates  with  exact- 
ness three  clinically  characteristic  groups  of  cases:  (1)  those  with 
increased  rates,  (2)  those  with  normal  rates,  and  (3)  those  with  de- 
creased metabolic  rates,  just  as  surely  and  just  as  definitely  as  the 
thermometer  divides  diseases  into  the  febrile  and  afebrile  groups. 

3.  Clinical  Calorimetry. — As  a  result  of  the  work  briefly  out- 
lined above  the  extended  use  of  indirect  calorimetry  in  clinical 
practice  has  been  rendered  feasible.  In  the  clinic  of  Profes- 
sor Edsall,  at  the  Massachusetts  General  Hospital  in  Boston, 
Means  and  his  associates,31' 44j  57>  58> 59j  60  using  Benedict's  unit  ap- 
paratus, investigated  the  metabolism  in  various  pathologic  condi- 
tions and  in  normal  controls.  At  the  Peter  Bent  Brigham  Hospital, 
Boston,  in  the  clinic  of  Professor  Harvey  Gushing,  metabolism 
studies  were  begun  in  1914  by  Boothby  and  Sandiford,  using  the 
gasometer  method  originally  introduced  by  Tissot  in  1904.  Both 
normal  and  various  pathologic  conditions  were  studied,27  but  most 
important  were  the  investigations  of  the  metabolic  findings  in  dis- 
orders of  the  pituitary  gland,  publication  of  which  has  been  delayed 
by  the  war. 

In  March,  1917  a  metabolism  laboratory  was  opened  at  the 
Mayo  Clinic  by  Boothby  and  Sandiford  under  the  clinical  direction 


1 8  BASAL    METABOLIC    RATE 

of  Professor  Henry  S.  Plummer.  In  the  treatment  of  the  large 
number  of  thyroid  cases  seen  at  the  clinic  our  results  have  definitely 
shown  how  essential  is  the  knowledge  of  the  basal  metabolic  rate 
in  pathologic  conditions  of  the  thyroid.  It  is  as  essential  as  a  knowl- 
edge of  the  temperature  in  febrile  cases.  With  the  wide-spread 
recognition  of  the  importance  of  the  basal  metabolic  rate  in  thyroid 
disorders  it  seems  advisable,  for  the  benefit  of  the  clinician  and 
surgeon,  to  give  briefly  a  description  of  the  methods  of  direct  and 
indirect  calorimetry,  of  the  various  kinds  of  apparatus  used  in 
indirect  calorimetry,  and  finally  to  give  in  detail  a  description  of 
the  apparatus  and  technic  used  in  our  laboratory  for  the  routine 
determination  of  the  basal  metabolic  rate. 

4.  Direct  and  Indirect  Calorimetry.  The  Respiration  Calorim- 
eter.— In  the  combined  method  of  direct  and  indirect  calorimetry 
the  production  and  elimination  of  heat  are  determined  by  means 
of  a  respiration  calorimeter54  which  may  be  denned  as  "an  appa- 
ratus designed  for  the  measurement  of  the  gaseous  exchange  be- 
tween a  living  organism  and  the  atmosphere  which  surrounds  it 
and  the  simultaneous  measurement  of  the  quantity  of  heat  pro- 
duced by  that  organism."55  A  complete  respiration  calorimeter, 
therefore,  combines  within  one  apparatus  two  separate  and  entirely 
distinct  methods :  the  one  determining  the  heat  production  and  the 
other,  the  heat  elimination,  thus  allowing  a  comparison  of  the  two 
principles. 

Heat  is  eliminated  from  the  body  in  two  ways :  first,  by  evapora- 
tion of  water  from  the  lungs  and  skin,  and  second,  by  radiation 
and  conduction.  The  amount  of  water  of  evaporation  is  deter- 
mined by  passing  the  air  in  the  calorimeter,  in  which  the  subject 
is  at  rest,  through  weighed  sulphuric  acid — the  gain  in  weight  of 
the  acid  is  the  weight  of  this  water.  Since  1  gram  of  vaporized 
water  contains  as  latent  heat  0.586  cal.,  the  gain  in  weight  of  the 
sulphuric  acid  multiplied  by  this  factor  is  the  amount  of  heat  lost 


DIRECT   AND    INDIRECT    CALORIMETRY  19 

by  evaporation  of  water — approximately  one-fourth  of  the  total 
heat  elimination. 

The  calorimeter  itself  measures  the  heat  given  off  from  the  body 
by  radiation  and  conduction.  The  apparatus  is  so  constructed 
that  there  is  no  heat  loss  through  the  walls  of  the  calorimeter,  and 
consequently,  to  prevent  the  temperature  within  the  chamber  from 
rising  to  that  of  the  body,  a  continuous  stream  of  water  is  kept 
circulating  through  copper  pipes  within  the  calorimeter;  by  this 
means  the  heat  eliminated  from  the  body  by  radiation  and  conduc- 
tion is  removed  and  its  amount  calculated  by  multiplying  the  total 
quantity  of  water  passed  through  the  calorimeter  during  the  test 
by  the  difference  in  temperature  (measured  to  0.01°  C.  by  electric 
resistance  thermometers)  between  the  outgoing  and  the  incoming 
streams  of  water.  The  heat  thus  calculated  is  subject  to  correc- 
tion, however,  if  the  temperature  of  the  subject  changes  during  the 
test,  or  if  the  temperature  of  the  wall  of  the  calorimeter  varies. 
The  measurement  by  the  calorimeter  of  the  heat  eliminated  by 
radiation  and  conduction  together  with  the  measurement  of  the 
heat  eliminated  by  evaporation  of  water  from  the  lungs  and  skin 
constitutes  the  method  of  direct  calorimetry. 

In  connection  with  the  calorimeter  a  respiration  apparatus  of 
the  Benedict  "unit,"6  or  closed-circuit  type  (more  fully  described 
below),  is  used  to  determine  the  respiratory  exchange,  that  is,  the 
oxygen  absorbed  and  the  carbon  dioxid  produced  by  the  subject 
in  a  known  time.  From  these  two  factors,  together  with  the  amount 
of  nitrogen  eliminated  in  the  urine,  it  is  possible  to  calculate  not 
only  the  heat  production  but  also  to  apportion  the  amount  of 
oxygen  used  for  the  burning  of  protein,  fat,  and  carbohydrate  in 
the  body.  This  is  the  method  of  indirect  calorimetry. 

The  respiration  calorimeter  requires  the  full  attention  of  at 
least  three  skilled  observers,  and  with  the  constant  repair  and  check- 
ing of  the  apparatus  and  the  long  preliminary  and  experimental 


20  BASAL    METABOLIC    RATE 

periods  each  of  at  least  one  hour's  duration  it  can  readily  be  seen 
that  the  combined  method  of  direct  and  indirect  calorimetry  is 
quite  beyond  extensive  clinical  use,  and,  moreover,  of  the  two 
methods,  the  indirect  is  to  be  preferred,  since  it  is  less  complicated 
than  the  direct.  It  was  necessary,  however,  first  to  determine  the 
agreement  between  the  two  methods  in  normal  and  in  pathologic 
conditions  before  indirect  calorimetry  could  be  used  to  measure  heat 
production. 

5.  Agreement  of  Direct  and  Indirect  Calorimetry. — Rubner 
showed  the  agreement  between  direct  and  indirect  calorimetry  on 
dogs  for  long  periods  and  Lusk53  for  short  hourly  periods;  Atwater 
and  Benedict  demonstrated  this  for  man  at  rest  and  at  woik,  and 
Rowland  for  babies  both  normal  and  atrophic.  Lusk  and  Du  Bois54 
have  shown  the  close  agreement  between  the  two  methods  in  normal 
and  in  all  pathologic  conditions  investigated  by  them,  and  have 
pointed  out  the  difficulties  involved  in  the  direct  method  and  of  the 
comparative  simplicity  of  the  indirect.  Gephart  and  Du  Bois39  con- 
clude that,  because  of  the  many  possible  sources  of  error  in  direct 
calorimetry,  especially  in  short  or  isolated  experiments,  "it  is  more 
desirable  to  use  the  method  of  indirect  calorimetry  as  the  standard, 
and  to  check  its  accuracy  by  the  level  of  the  respiratory  quotient 
and  the  agreement  with  the  direct  calorimetry." 

6.  Indirect  Calorimetry. — Krogh,  of  Copenhagen,  and  Car- 
penter, of  the  Carnegie  Nutrition  Laboratory,  have  described  and 
compared  in  great  detail  the  various  kinds  of  respiration  apparatus 
used  in  indirect  calorimetry.  Carpenter  has  shown  that  for  indirect 
determinations  two  types  of  apparatus  are  suitable — the  closed 
circuit  and  the  gasometer. 

(a)  Unit  Apparatus. — By  far  the  best  apparatus  of  the  closed- 
circuit  type  is  the  Benedict  unit  apparatus.6  By  means  of  a  mask, 
mouth-,  or  nose-piece  the  subject  rebreathes  air  from  a  closed  system 
in  which  the  carbon  dioxid  produced  is  absorbed  by  soda  lime,  and 


INDIRECT    CALORIMETRY  21 

as  the  oxygen  is  consumed  it  is  replaced  by  oxygen  in  known 
amounts.    The  air  within  the  apparatus  is  kept  in  constant  circula- 
tion by  means  of  a  blower.    A  small  spirometer  is  inserted  in  the 
circuit  as  an  expansion  chamber  and  records  volumetrically  on  a 
smoked  drum  the  respiratory  movements.     Knowing  the  weights 
of  oxygen  used  and  carbon  dioxid  produced,  one  can  readily  cal- 
culate the  heat  production.     As  pointed  out  by  Carpenter,  this 
apparatus  is  very  satisfactory  and,  indeed,  the  best  for  many  pur- 
poses, especially  when  used  in  conjunction  with  a  calorimeter  or 
with  the  "cot-chamber  calorimeter"  described  by  Benedict  and 
Tompkins.     We  have  found,  however,  that  for  clinical  work  the 
unit  apparatus  is  rather  cumbersome.    It  requires  constant  checking 
to  see  that  it  is  absolutely  air  tight,  for  a  leak  even  of  a  few  cubic 
centimeters  either  in  the  apparatus  or  in  the  adjustment  of  the 
mask,  during  a  fifteen-minute  determination,  will  appreciably  affect 
the  result,  because  such  a  leak  in  this  type  of  apparatus  will  be 
equivalent  to  the  loss  of  so  much  oxygen  and  not  equivalent  to  the 
loss  of  so  much  air,  as  is  the  case  in  the  gasometer  method,  thus 
magnifying   the   error   five   times.     Furthermore,   the  accumula- 
tive errors  of  the  apparatus  fall  on  the  oxygen  and  not  on  the  car- 
bon dioxid  determination,  thus  causing  errors  in  the  calculation 
of  the  respiratory  quotient  and  heat  production.     The  absorbing 
chemicals  must  be  changed  frequently,  and  with  the  repairing  and 
constant  checking  of  the  apparatus  it  is,  on  the  whole,  difficult  to 
use  in  clinical  work,  particularly  if  many  determinations  are  to  be 
made. 

(b)  Portable  Unit  Apparatus. — The  portable  respiration  ap- 
paratus recently  devised  by  Benedict12' 13)  21  for  clinical  work  is  a 
modification  of  his  unit  apparatus  described  above.  It  is  designed 
primarily  to  give  a  rapid  and  at  the  same  time  a  comparatively 
accurate  measurement  of  the  oxygen  consumption  without  involv- 
ing analyses  or  weighing.  We  have  not  adopted  this  apparatus  for 


22  BASAL    METABOLIC    RATE 

routine  work,  as  we  prefer  to  determine  with  greater  accuracy 
not  only  the  oxygen  consumption  but  also  the  carbon  dioxid  elim- 
ination, since  the  heat  production  can  thereby  be  more  exactly  cal- 
culated. Moreover,  the  difficulties  inherent  in  the  closed-circuit 
type  of  apparatus  mentioned  above  are  still  present  in  the  portable 
unit.  In  addition,  in  the  early  models  there  is  the  danger  of  the 
oxygen-rich  mixture  catching  on  fire,  which,  although  it  may  not 
injure  the  patient,  is  at  least  disconcerting.  The  chief  objection 
to  the  apparatus  for  clinical  work  is  the  fact  that  it  cannot  be 
cleaned  and  the  patient  is  exposed  to  the  serious  danger  of  infection 
by  rebrea thing  contaminated  air. 

(c)  Gasometer. — For  clinical  work  the  gasometer  method  in- 
troduced by  Tissot  in  1904  is  considered  by  us  the  most  satisfactory. 
Briefly,  the  determinations  are  made  in  the  following  manner:  A 
mask  is  tightly  adjusted  over  the  patient's  mouth  and  nose  and,  by 
means  of  expiratory  and  inspiratory  valves,  the  total  volume  of 
the  patient's  expired  air  is  collected  in  a  gasometer  for  a  known 
period  of  approximately  ten  minutes.  Duplicate  determinations 
are  made  of  the  carbon  dioxid  and  oxygen  content  of  the  expired 
air,  the  analyses  being  done  in  the  Haldane  gas  analysis  apparatus. 
Since  the  ventilation  rate  for  each  minute  is  known  and  the  per- 
centages of  carbon  dioxid  produced  and  oxygen  absorbed,  it  is  pos- 
sible to  calculate  by  means  of  calorie  tables  the  total  calories  pro- 
duced each  hour. 

The  gasometer  method  is  particularly  suitable  for  clinical  work 
because  each  step  in  the  procedure  can  be  checked  by  a  second 
assistant,  reducing  to  a  minimum  the  chance  of  technical  errors. 
Unlike  in  the  work  with  the  closed-circuit  apparatus,  no  appre- 
ciable error  is  introduced  by  failing  either  to  start  or  to  stop  the 
experimental  period  at  exactly  the  end  of  a  normal  respiration,  a 
difficult  thing  to  do  with  accuracy  in  the  case  of  patients  who 
breathe  irregularly.  Furthermore,  the  air  inspired  by  the  patient 


INDIRECT    CALORIMETRY  23 

is  fresh,  clean  air  and  not  the  exhalations  of  previous  patients,  as 
in  the  closed-circuit  type  of  apparatus.  Moreover,  all  parts  of  the 
apparatus  that  come  in  contact  with  the  patient  or  with  the  air 
that  he  breathes  can  be  thoroughly  cleaned.  Although  the  method 
requires  care  and  accuracy  in  every  part  of  the  procedure,  it  is  pos- 
sible to  teach  the  technic  to  laboratory  workers  who  have  had  no 
preliminary  scientific  training  other  than  that  obtained  in  high 
school.  The  most  difficult  step  in  the  procedure  is  the  analysis  of 
the  expired  air.  This,  however,  we  have  found  to  be  inconsiderable. 
Our  assistants  can  obtain  routinely  duplicate  analyses  agreeing 
within  0.04  per  cent,  for  carbon  dioxid  and  0.06  per  cent,  for  oxygen, 
and  they  are  able  also  to  take  entire  care  of  their  gas  analysis 
apparatus.  The  equipment  necessary  for  this  method  is  simple 
and  inexpensive,  and  if  properly  constructed  is  rarely  out  of  order 
and,  except  for  cleaning,  requires  very  little  mechanical  care.  Fur- 
thermore, the  apparatus  is  free  from  the  many  mechanical  difficulties 
inevitably  inherent  in  a  closed-circuit  system  in  which  the  air  cur- 
rent is  driven  by  an  electric  pump.  In  the  metabolism  laboratory 
at  the  Mayo  Clinic  we  have  done  more  than  12,000  tests  and  are 
now  averaging  32  cases  a  day,  and  have  developed  a  very  definite 
and  routine  procedure  which  has  decreased  the  probability  of  a 
technical  error  occurring  in  less  than  1  per  cent,  of  the  tests.  « 


SECTION  II 

DETAILS    OF   TECHNIC 

A.  THE  PATIENT 

1.  Postabsorptive  Condition. — Since  the  time  of  Lavoisier  the 
influence  of  food  on  the  metabolic  processes  has  been  recognized. 
In  a  series  of  investigations  on  food  ingestion  Benedict  and  Car- 
penter16 conclude  "that  the  ingestion  of  all  kinds  of  food  in  any 
amount  results  in  an  increment  in  the  metabolism."    The  mechan- 
ical work  of  chewing  and  even  the  drinking  of  liquids,  especially 
in  large  amounts,  increase  the  metabolism,  although  the  increases 
are  small.    Lusk  found  that  in  man  the  increase  in  heat  production 
after  a  large  protein  meal  amounted  to  46  per  cent,  and  the  effect 
did  not  disappear  for  about  twelve  hours;  with  carbohydrate  and 
fat  the  result  was  less  striking,  but  a  rise  of  20  per  cent,  was  not 
uncommon.    Soderstrom,  Barr,  and  Du  Bois  studied  the  effect  on 
the  metabolism  of  a  small  breakfast  of  bread,  coffee,  milk,  and 
sugar,  totaling  222  cal.,  and  showed  that  there  was  an  average 
increase  of  7  per  cent,  in  the  first  hour  after  such  a  breakfast,  and 
in  the  second  and  third  hours,  2  per  cent.     In  other  words,  the 
effect  was  small  and  of  short  duration.    Benedict,  however,  rightly 
insists  that  the  subject  should  be  in  the  so-called  "postabsorptive" 
state  when  absorption  of  material  from  the  alimentary  tract  has 
ceased,  this  being  with  adults  generally  twelve  hours  after  the  last 
meal.     For  this  reason  we  require  all  our  patients  to  go  without 
breakfast  and  caution  them  not  to  eat  heartily  the  night  before  the 
test. 

2.  Muscular  Activity. — Much  of  the  earlier  work  on  metabolism 

was  vitiated  because  the  subjects  were  not  quiet  during  the  test. 

24 


PRELIMINARY   REST   PERIOD  25 

Benedict  and  Carpenter15  have  repeatedly  emphasized  the  impor- 
tance of  complete  muscular  repose,  and,  in  fact,  they  use  a  recording 
device  to  obtain  graphic  records  of  the  degree  of  activity  of  the 
subject.  For  a  time  we  made  use  of  similar  graphic  records,  but 
have  found  it  more  satisfactory  to  have  one  of  our  laboratory 
assistants  with  the  patient  to  record  any  body  movements  and  to 
evaluate  their  significance  at  the  time  of  the  observation  instead  of 
attempting  later  to  interpret  a  tracing. 

3.  Preliminary  Rest  Period. — Benedict  and  Carpenter16  advise, 
furthermore,  that  there  should  be  a  preliminary  rest  period  of  at 
least  thirty  minutes  or  preferably  longer,  so  that  one  may  be  cer- 
tain that  the  basal  level  has  been  reached.  We  require  a  prelim- 
inary rest  period  of  at  least  twenty  minutes  before  the  mask  is 
adjusted.  It  is  obviously  desirable  when  many  cases  are  being 
studied  to  make  this  rest  period  as  short  as  possible  and  yet  of 
sufficient  length  to  obtain  the  basal  rate.  With  this  point  in  view 
we  have  studied  44  cases  in  which  the  metabolic  rate  was  deter- 
mined after  varying  preliminary  periods  of  rest.  The  data  are 
summarized  in  Tables  2  and  3.  It  will  be  seen  that  in  these  44 
cases  there  is  no  material  difference  in  the  average  metabolic  rate 
produced  by  the  prolongation  of  the  preliminary  rest  period  beyond 
twenty  minutes.  Sixteen  of  the  patients  showed  a  decrease  in  the 
metabolic  rate  as  a  result  of  resting  over  one-half  hour;  7  cases 
showed  no  change,  and  21  cases  showed  not  a  decrease  but  an 
increase  in  the  metabolic  rate  by  prolonging  the  rest  period,  pos- 
sibly due  to  the  tendency  of  certain  patients  to  be  annoyed  and 
irritated  by  the  delay.  Du  Bois  also  found  "a  distinct  tendency  for 
the  patient  to  become  more  restless  as  the  observation  progresses,"37 
and  showed  that  the  metabolism  is  usually  higher  in  the  second 
hour  than  in  the  first. 

In  another  group  of  20  cases  we  determined  the  metabolic  rate 
directly  the  patient  went  to  bed,  and  then  made  a  second  determi- 


26 


BASAL    METABOLIC   RATE 


nation  after  the  patient  had  been  resting  quietly  for  at  least  twenty 
minutes.     The  average  metabolic  rate  of  these  20  cases  determined 

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without  any  preliminary  rest  period  was  +37  per  cent.,  and  after 
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PRELIMINARY    REST   PERIOD 


showing  a  marked  decrease  as  a  result  of  the  rest  period.  The 
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minutes  is  a  sufficiently  long  rest  for  the  determination  of  the  basal 
metabolic  rate,  provided  no  strenuous  exercise  preceded  the  rest 
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28 


EFFECT    OF    BODY    TEMPERATURE  2Q 

of  several  days'  or  even  weeks'  duration  has  not  been  thoroughly 
investigated.  It  is  not  unlikely  that  even  normal  persons  may  have 
a  slightly  lower  basal  metabolic  rate  after  prolonged  rest  in  bed. 
Such  a  decrease,  if  it  does  occur  in  normal  persons,  must  be  slight, 
for  Boothby  has  found  that  the  basal  metabolic  rates  of  23  patients 
who  recovered  their  health  after  operations  and  who  had  been  con- 
fined in  the  hospital  for  between  twenty  and  fifty  days,  most  of  the 
time  in  bed,  were  within  ±10  per  cent,  of  the  Du  Bois  normal 
standard.  As  Lusk55  states,  this  establishes  the  validity  of  the  use 
of  this  measure  of  the  basal  metabolism  as  a  criterion  of  an  altered 
metabolism  in  hospital  patients.  We  have  found,  however,  that 
there  is  an  average  decrease  in  the  basal  metabolic  rate  of  approxi- 
mately 10  per  cent,  in  patients  with  hyperthyroidism  produced  by 
several  days'  rest  in  bed;  in  some  of  the  cases  the  drop  in  the  meta- 
bolic rate  is  very  marked,  while  in  others  it  is  slight.  Such  a  decrease 
when  it  occurs  can  rightly  be  interpreted  as  indicating  a  decrease 
in  the  hyperthyroid  intoxication  of  the  patient,  and  therefore  a 
general  improvement  in  his  condition  due  to  the  rest  in  bed. 

4.  Effect  of  Body  Temperature. — The  fluctuations  in  the  body 
temperature  that  occur  from  day  to  day  in  normal  healthy  per- 
sons,15 while  possibly  accompanied  by  corresponding  slight  varia- 
tions within  normal  limits  of  the  basal  metabolic  rate,  are  of  no 
importance  clinically.  If  the  temperature  is  elevated  above  the 
normal  limits  (99°  F.),  however,  the  metabolic  rate  is  materially 
increased.  This  has  been  shown  in  typhoid  fever  by  Coleman  and 
Du  Bois,  and  in  malaria  by  Du  Bois  and  Barr.  We  have  repeatedly 
and  consistently  observed  an  increase  in  the  metabolic  rate  above 
an  individual's  basal  level  as  a  result  of  the  development  of  a  cold, 
sore  throat,  tonsillitis,  or  other  infection  accompanied  by  a  rise  in 
the  body  temperature.  Therefore  whenever  the  significance  of  the 
basal  metabolic  rate  is  being  studied,  the  presence  of  a  febrile  con- 
dition must  be  ruled  out  by  carefully  obtaining  the  body  tempera- 


30  BASAL    METABOLIC    RATE 

ture.  For  instance,  no  conclusions  as  to  the  degree  of  primary 
over-  or  underactivity  of  the  thyroid  gland  are  justified  from  the 
level  of  the  basal  metabolic  rate  unless  the  temperature  at  the  time 
of  the  test  is  normal. 

5.  Character  of  Respiration. — In  controlling  patients  we  have 
considered  it  very  important  to  impress  on  them,  particularly  if  it 
is  their  first  test,  the  necessity  of  breathing  naturally.     Patients 
have  a  tendency  to  vary  the  depth  and  regularity  of  their  respira- 
tions during  the  test.     While  this  does  not  affect  the  total  metab- 
olism materially,  nevertheless  it  does  alter  the  respiratory  quo- 
tient.    If  there  is  forced  breathing  during  the  test,  carbon  dioxid 
is  washed  out  of  the  body,  and  since  the  oxygen  absorption  is  not 
correspondingly  affected,  the  respiratory  quotient,  in  consequence, 
will  be  high.    On  the  other  hand,  if  the  patient  force  breathes  shortly 
before  the  determination  and  the  mask  is  adjusted  before  the  carbon 
dioxid  has  again  accumulated  to  the  normal  in  the  body,  then  the 
respiratory  quotient  will  tend  to  be  low  (Douglas  and  Haldane, 
Boothby28).    If  as  a  result  of  this  abnormal  breathing  the  resultant 
respiratory  quotient  is  either  below  0.71  or  above  1.00,  the  calcula- 
tions are  carried  out  as  though  the  quotients  were  0.71  and  1.00 
respectively.    Such  abnormal  quotients  indicate,  as  a  rule,  a  ner- 
vous condition  on  the  part  of  the  patient  or  an  error  in  technic. 
It  is  advisable,  therefore,  to  repeat  such  cases,  although  we  have 
rarely  found  a  sufficient  change  in  the  check  determination  to  affect 
the  clinical  value  of  the  previous  test. 

6.  Effect  of  Sleep. — Benedict  and  Carpenter16  consider  it  im- 
portant to  note  any  drowsiness  or  sleep  which  may  occur  during 
the  test.    "The  effect  of  external  muscular  activity  is  to  change  the 
total  metabolism,  while  the  effect  of  drowsiness  or  sleep  is  to  change 
the  apparent  character  of  the  respiratory  exchange."    They15  also 
found  the  metabolism  8  to  10  per  cent,  higher  when  the  subject 
was  lying  awake  than  when  he  was  sleeping.     In  clinical  work, 


BODY   POSITION  31 

however,  it  rarely  happens  that  a  patient  falls  asleep  during  the 
test. 

7.  Body  Position. — The  question  of  body  position  as  a  factor  in 
the  determination  of  the  basal  metabolic  rate  must  be  considered. 
Benedict  and  Joslin  state  that  the  metabolism  as  measured  in  the 
chair  calorimeter  is  some  20  to  30  per  cent,  greater  than  with  the 
bed  calorimeter  or  with  the  respiration  apparatus.  However,  as 
they  point  out  that  there  was  a  variable  amount  of  muscular  move- 
ment in  the  experiments  quoted  above,  we  consider  that  these  re- 
sults do  not  necessarily  indicate  the  true  effect  of  body  position. 
Johansson  found  the  carbon  dioxid  output  6  per  cent,  higher 
when  the  subject  was  sitting  than  when  lying.  Emmes  and  Riche, 
using  the  unit  apparatus,  found  that  the  oxygen  consumption  aver- 
aged 7.6  per  cent,  higher  with  the  subject  sitting  upright  in  a  chair 
with  the  head  supported  than  when  lying  flat  in  bed.  Soderstrom, 
Meyer,  and  Du  Bois  conclude  that  the  metabolism  averages  3  per 
cent,  lower  with  the  patient  in  the  semireclining  position  than  when 
lying  at  rest.  We  carried  out  a  short  series  of  experiments  to  de- 
termine the  metabolic  rate  when  the  patient  was  sitting  at  rest  in 
a  straight-backed  chair  and  when  lying  at  rest.  The  patient  was 
allowed  to  rest  quietly  in  bed,  flat  on  his  back,  twenty  minutes  be- 
fore the  first  metabolic  rate  determination  was  made.  At  the  end  of 
this  test  the  patient  was  arranged  in  a  fairly  comfortable  straight- 
backed  chair,  with  or  without  head  support,  and  again  allowed  to 
rest  quietly  twenty  minutes  before  the  metabolic  rate  was  deter- 
mined. The  data  are  summarized  in  Table  5.  The  average  meta- 
bolic rate  in  the  24  cases  studied  with  the  patients  seated  in  a  chair 
was  +29  per  cent.,  and  when  lying  at  rest  in  bed  it  was  +27  per 
cent.  Thirteen  of  these  cases  showed  an  average  increase  of  7 
points  in  the  metabolic  rate  when  sitting  in  the  chair  over  the  rate 
determined  in  bed;  2  cases  remained  unchanged  and  9  showed  an 
average  decrease  of  5  points.  These  results  demonstrate  no  con- 


32  BASAL   METABOLIC   RATE 

sistent  variation  in  the  basal  metabolic  rate  due  to  body  position. 
The  slight  variations  found  are  probably  due  to  a  more  complete 
muscular  relaxation  with  greater  comfort  in  one  instance  than  in 
the  other,  with  the  probabilities  of  obtaining  a  lower  and,  there- 
fore, a  truer  basal  metabolic  rate  in  bed.  For  this  reason  we  carry 
out  practically  all  our  determinations  with  the  patients  in  bed,  flat 
on  their  backs,  although  we  do  not  hesitate  to  allow  a  patient  to 
be  in  a  semireclining  position  if  he  is  thereby  made  more  com- 
fortable. 

8.  Observer's  Chart. — A  careful  record  is  kept  of  each  patient 
while  in  the  laboratory  (Form  I,  Appendix).  The  time  at  which 
the  preliminary  rest  period  begins,  that  is,  immediately  when  the 
patient  is  comfortable  in  bed,  is  recorded,  and  during  this  period 
several  counts  of  the  heart  and  respiration  rates  are  made.  The 
heart-beat  is  counted  for  the  full  minute  by  means  of  a  stethoscope 
at  the  apex  of  the  heart  and  the  observer  notes  whether  the  heart- 
beat is  regular  or  irregular.  The  rate  and  character  of  the  respira- 
tion, whether  shallow,  deep,  forced,  regular,  or  irregular,  are  re- 
corded. The  temperature  and  blood-pressure  are  taken  after  the 
patient  has  rested  quietly  in  bed  for  ten  minutes.  For  our  blood- 
pressure  readings  we  use  a  Tycos  apparatus  and  take  the  systolic 
reading  at  the  point  at  which  the  sound  first  comes  through  and 
the  diastolic  reading  the  third  phase,  that  is,  the  point  at  which 
the  sound  begins  to  be  "muffled,"  which  is  synchronous  with  a 
sudden  decrease  in  the  amplitude  of  the  swing  of  the  needle. 

At  the  end  of  the  twenty-minute  rest  period  the  mask  is  adjusted 
with  the  precautions  given  on  page  35.  With  the  arrangement  of 
•our  apparatus  it  is  possible  for  the  observer  to  see  when  the  valve 
on  the  gasometer  is  turned  on  to  the  patient  or  off,  so  that  the  exact 
time  to  the  seconds  of  starting  and  ending  the  test  can  be  noted  by 
the  observer.  The  observer's  time  should  agree  within  five  seconds 
of  the  reading  on  the  stop-watch,  thus  giving  a  check  on  gross 


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34  BASAL    METABOLIC    RATE 

misreading  of  the  latter.  When  the  mask  is  on,  a  complete  record 
of  the  patient's  mental  and  physical  condition  is  kept,  as  ^ell  as 
of  the  pulse  and  respiration  rates.  Thus  the  observer  notes  whether 
the  patient  is  quiet,  records  any  movements,  whether  slight  or 
marked,  and  whether  the  patient  was  apparently  asleep  or  nervous 
and  worried.  At  the  end  of  the  test  the  patient's  height  (bare  feet) 
in  centimeters  and  weight  (without  clothing)  in  kilograms  are 
recorded  and  checked. 

9.  Repetition  of  Test. — The  necessity  for  a  repetition  of  the  test 
is  dependent  on  two  distinct  considerations — the  avoidance  of 
technical  laboratory  mistakes  and  the  elimination  of  physiologic 
errors. 

Laboratory  errors  are  best  detected  and  avoided  by  doing  two 
complete  determinations  each  time  the  patient  comes  to  the  labora- 
tory until  the  laboratory  routine  has  become  so  perfected  that 
material  variations  in  the  results  of  the  duplicate  tests  do  not  occur. 

Physiologically,  however,  in  an  extremely  nervous  person  a 
basal  rate  occasionally  cannot  be  obtained  the  first  time  the  patient 
comes  to  the  laboratory.  In  order  to  rule  out  the  effect  of  nervous- 
ness or  temporary  slight  indisposition  the  patient  is  instructed  to 
return  the  following  morning  for  a  second  test,  instead  of  repeating 
the  determination  on  the  same  day.  In  such  instances  the  meta- 
bolic rate  will  occasionally  be  as  much  as  10  points  lower  than  that 
obtained  at  the  first  test  when  the  patient  was  unduly  nervous  and 
frightened  about  an  unknown  procedure,  often  aggravated  by  rest- 
lessness during  the  preceding  night.  A  check  reading  is  particularly 
important  in  those  patients  who  have,  on  their  preliminary  tests, 
metabolic  rates  between  +10  and  +20  per  cent,  because  slight 
errors  in  this  range  have  a  greater  relative  significance,  and  there- 
fore even  the  slight  effect  of  nervousness  must  be  ruled  out. 

In  conclusion  it  must  be  said  that  it  is  essential  to  secure  the  co- 
operation of  the  patients  for  correct  metabolic  rates,  and  one  must 


MASK  35 

impress  on  them  the  necessity  of  lying  absolutely  quiet  by  explaining 
that  muscular  movement  increases  the  metabolism  and  so  renders 
their  test  inaccurate. 

B.  THE   GASOMETER  AND   ACCESSORY  APPARATUS* 

1.  Mask. — Hendry,  Carpenter,  and  Emmes  have  shown  that 
the  oxygen  consumption  is  practically  the  same  regardless  of  the 
breathing  appliance  used.  We  have  found,  however,  that  in  clin- 
ical work  the  patients  object  strenuously  to  the  mouth-piece,  and 
furthermore,  that  it  requires  intelligent  co-operation  on  their  part 
to  introduce  it  correctly  and  to  keep  it  air-tight  throughout  the 
observation.  Once  the  mouth-piece  is  in  place  there  is  a  tendency 
to  excess  saliva,  the  drooling  of  which  is  most  disagreeable.  A 
gas  mask  (Fig.  1)  of  the  type  used  for  mine  rescue  work  is  much 
more  satisfactory.  The  mask  is  made  of  rubber  fitted  over  a  flex- 
ible metal  framework,  so  that  it  is  possible  to  mold  it  to  the  shape 
of  the  individual  face.  The  face-piece  has  a  pneumatic  rim  around 
its  edge,  but  it  is  much  safer  not  to  inflate  it,  for  the  air  valve 
attached  to  the  rim  tends  to  leak,  thus  altering  the  pressure  of  the 
mask  against  the  face,  with  the  consequent  result  that  it  may  not 
be  air-tight. 

The  mask  should  be  fitted  to  the  patient's  face  and  held  securely 
in  place  by  means  of  tapes  tied  in  various  positions  across  the  mask. 
For  convenience  twelve  tapes  are  sewed  on  each  side  of  a  narrow 
towel  which  is  about  6  inches  wide  and  18  inches  long.  The  towel 
is  placed  on  the  pillow  under  the  patient's  head  and  the  various 
tapes  can  be  used  to  tie  the  face-piece  securely  without  disturbing 
the  patient.  One  pair  of  tapes  is  tied  over  the  mask  at  the  nose  and 
another  pair  around  the  chin  (Fig.  2).  Two  pairs  of  tapes  are  then 
tied  crosswise  over  the  mask,  a  pair  over  the  nose,  and  a  final  pair 

*  The  entire  apparatus  may  be  obtained  from  H.  N.  Elmer,  1135  Monad- 
nock  Building,  Chicago,  111. 


BASAL    METABOLIC    RATE 


Expiratory  valves 
C  orvrve  c  "bi  on,  s 


Mask/" 

Towel   u/itH   tap€S--j 


Fig.  1. — Mask  and  connections  showing  valves  and  intake  pipe. 

around  the  chin  (Fig.  3).     The  most  frequent  source  of  leaks  is 
around  the  nose  and  at  either  of  the  two  corners  of  the  mask,  and 


MASK 


37 


extreme  care  must  be  taken  to  avoid  them.    Smearing  the  face  with 
vaselin  is,  however,  unnecessary. 

The  mask  and  connections  are  kept  clean  by  washing  thor- 
oughly with  soap  and  water  and  finally  by  rinsing  with  bichlorid 
solution  (1  :  1000).  The  mask  itself  should  be  frequently  tested 


Fig.  2. — Mask  with  two  pairs  of  tapes  adjusted. 

for  tightness.  To  do  this  rubber  corks  are  inserted  in  the  connec- 
tions and  both  face-piece  and  connections  are  then  completely  filled 
with  water  and  allowed  to  stand  one-half  hour.  It  will  be  found 
that  the  mask  usually  gives  way  first  at  the  nose. 

2.  Valves. — Carpenter  has  given  an  excellent  discussion  of  the 
various  types  of  air  valves  and  of  their  relative  efficiency.     Up  to 


38  BASAL   METABOLIC    RATE 

the  present  time  we  have  preferred  the  Douglas  valves  with  mica 
flaps,  although,  as  Carpenter  has  shown,  they  may  have  an  effi- 
ciency of  only  75  per  cent.  We  overcome  this  defect  by  using  two 
of  these  valves  on  the  inspiratory  side  at  about  2  feet  distant  from 
the  mask  and  one  valve  on  the  expiratory  side  (Fig.  1).  With  this 


Fig.  3. — Mask  with  six  pairs  of  tapes  adjusted. 

arrangement  the  loss  of  any  expired  air  can  be  completely  avoided, 
because  if  a  slight  leak  in  the  valves  should  occur  the  expired  air 
would  pass  back  a  short  distance  into  the  inspiratory  tubes,  but 
would  not  reach  the  double  inspiratory  valves;  this  expired  air 
would  be  rebreathed  on  the  next  inspiration  and,  therefore,  would 
not  be  lost.  There  is  very  little  resistance  from  these  valves  to  the 


VALVES 


39 


passage  of  air,  so  that  they  cause  no  respiratory  discomfort  to  the 
patient,  and  they  are,  moreover,  sufficiently  large  to  take  care  of 
any  volume  of  air  that  a  patient  breathes,  even  under  conditions  of 


Fig.  4. — Rubber  flutter  valve  assembled. 

extreme  muscular  exertion.  A  distinct  improvement  has  been  made 
recently  in  the  Douglas  valve  by  the  substitution  of  a  rubber  in 
place  of  a  mica  flap. 

By  far  the  most  efficient  air  valve  is  the  rubber  flutter  valve 


40  BASAL    METABOLIC    RATE 

devised  by  the  British  during  the  war  for  use  on  the  antigas  masks. 


Fig.  5. — Various  parts  of  rubber  flutter  valve. 

The  valve  offers  very  slight  and  negligible  resistance  to  the  passage 
of  air  and  yet  is  absolutely  tight,  as  proved  repeatedly  by  the  fact 


INTAKE   PIPE  41 

that  the  men  were  able  to  stay  without  any  danger  in  extremely 
high  concentrations  of  the  most  deadly  gases  when  the  slightest 
leak  would  have  been  fatal.  As  used  on  the  British  and  American 
gas  masks  the  valve  opened  into  the  atmosphere.  To  adapt  the 
valve  to  our  work  necessitated  the  construction  of  a  metal  air- 
tight container  suitably  designed  to  insert  in  the  air  circuit  (Figs. 
4  and  5). 

3.  Intake  Pipe. — -(a)  Outdoor  Air. — With  the  stationary  gas- 
ometers in  the  laboratory  the  two  inspiratory  valves  are  mounted 
on  a  large  intake  pipe  (Fig.  1)  about  2  inches  in  diameter  which 
leads  out  of  doors  so  that  the  subject  inspires  outdoor  air  which 
has  a  known  constant  composition:  0.04  per  cent,  carbon  dioxid 
and  20.93  per  cent,  oxygen  (page  78).  The  intake  pipe  can  easily 
be  put  up  in  any  laboratory  and,  if  possible,  should  always  be 
used. 

(b)  Room  Air. — The  air  in  patients'  rooms  in  one  of  the  Roch- 
ester Hospitals  varied  on  analysis  between  0.04  per  cent,  carbon 
dioxid  and  20.93  per  cent,  oxygen  to  0.34  per  cent,  carbon  dioxid 
and  20.70  per  cent,  oxygen;  the  average  of  100  determinations  of 
the  air  from  different  rooms  was  0.11  per  cent,  carbon  dioxid  and 
20.84  per  cent,  oxygen.  In  case  room  air  of  this  average  composi- 
tion is  used  and  no  correction  made  for  it  in  the  calculations  the 
resulting  metabolic  rate  will  be  too  high  by  3  to  6  points;  if  there  is 
more  than  0.30  per  cent,  of  carbon  dioxid  with  a  corresponding 
decrease  in  the  oxygen  content  the  error  in  the  metabolic  rate  may 
be  as  high  as  16  points.  On  the  other  hand,  analyses  of  the  room 
air  made  before  and  after  opening  the  window  wide  show  that  three 
to  five  minutes  is  sufficient  to  render  the  composition  of  the  room 
air  within  0.02  per  cent,  of  that  of  out-door  air,  a  neglect  of  which 
will  produce  no  appreciable  error  in  the  calculated  metabolic  rate. 
With  the  movable  gasometer  it  is  more  convenient  in  routine  work 
to  air  the  room  by  opening  the  window  wide  from  three  to  five 


42  BASAL    METABOLIC   RATE 

minutes  during  the  preliminary  period  than  to  carry  an  extra  long 
inspiratory  tube  that  will  reach  out-doors.  When  using  room  air 
the  inspiratory  tube  consists  of  corrugated  tubing,  2  or  3  feet  long, 
with  double  inspiratory  valves;  the  tubing  is  hung  over  the  top  of 
the  bed  so  that  the  valves  are  upright.  It  must  be  remembered 
that  variations  in  the  metabolic  rate  of  3  or  4  points  cannot  be  con- 
sidered significant  unless  either  out-door  air  has  been  used  or  con- 
trol analyses  made  of  the  composition  of  the  room  air  at  the  site  of 
the  opening  of  the  inspiratory  tube  at  the  time  of  the  test. 

4.  Connections  are  made  from  the  valves  to  the  mask  by  corru- 
gated tubing  (Fig.  1)  which  does  not  tend  to  collapse  or  kink  and 
thus  cut  off  the  air  supply  to  the  patient.    They  are  made  sufficiently 
long  to  meet  the  needed  requirements  by  joining  various  lengths  of 
the  corrugated  tubing  by  brass  connections.     With  the  movable 
gasometer  the  connections  are  long  enough  so  that  the  apparatus 
during  a  test  may  be  stationed  just  outside  the  patient's  room. 
When  using  a  long  connecting  tube  additional  time  is  necessary  to 
wash  out  the  increased  dead  space  with  the  expired  air  (page  51). 
The  tubing  must  be  carefully  watched  for  leaks,  because  the  car- 
bon dioxid  of  the  expired  air  tends  to  rot  the  rubber.    To  do  this 
the  tubes  should  be  filled  with  water  and  hung  up  for  ten  minutes. 
A  leak  in  the  tubing  will  allow  the  water  to  trickle  through  on  to 
the  dry  outer  linen  covering  and  so  is  readily  detected. 

5.  Gasometer. — The    gasometer   method    of    determining    the 
respiratory  exchange  was  introduced  by  Tissot  in  1904,  and  has 
been  extensively  used  in  French  and  in  American  laboratories. 
A  complete  description  of  the  original  apparatus  and  the  technic 
used  in  Chauveau's  laboratory  is  given  by  Carpenter. 

Although  the  fundamental  principles  of  the  Tissot  spirometer 
have  not  been  changed,  a  few  alterations  in  detail  render  the  form 
of  apparatus  used  by  us  more  convenient  for  clinical  use.  Figures 
•6,  7,  and  9  illustrate  the  design  of  our  apparatus  as  perfected  by 


GASOMETER 


43 


_  -  -T  h,  er  m  om  eter 
Rubbev    stoppev 


Sampling  pet 


To  room, 


Outer*    wall 
oj"    water    s«sal 


,Y  Patieut  to  room  a,i,T' 


patieut 


Patiervt    to 
gasorrueber 


Drainage   pet-cock.--' 
Fig.  .6 — Cross-section  of  gasometer  . 


Fig.  7. — Stationary  gasometer. 


44 


GASOMETER  45 

Mr.  George  Little  of  the  clinic  instrument  shop.    The  gasometers 


Fig.  8. — Gasometer  room. 

in  the  laboratory  are  stationary  and,  in  addition,  we  have  a  gasom- 
eter mounted  on  wheels  and  of  slightly  smaller  capacity  (Fig.  9) 


Fig.  9. — Movable  gasometer." 


GASOMETER  47 

With  this  movable  apparatus  it  is  possible  to  test  the  patients  in 
their  rooms,  which  is  of  considerable  advantage. 

The  gasometer  (Figs.  6,  7,  9)  consists  of  a  thin  copper  bell,  of 
approximately  125  liters  capacity,  suspended  in  a  water-bath  be- 
tween double  walls  of  a  hollow  cylinder  which  is  closed  at  the  top, 
except  for  the  inlet  and  outlet  tubes.  The  counterpoise  of  the  bell 
is  hung  over  ball-bearing  wheels  by  means  of  steel  piano  wire. 
The  main  weight  of  the  bell  is  balanced  by  a  long,  hollow  brass  tube 
(counterpoise  tube)  on  the  lower  end  of  which  are  placed  the 
necessary  lead  weights  to  counterbalance  the  bell  exactly.  To 
compensate  for  the  increase  in  weight  of  the  gasometer  bell  as  it. 
rises  out  of  the  water  seal  a  quantity  of  water  equal  to  the  increase 
in  the  weight  of  the  bell  siphons  from  a  small  reservoir  into  the 
hollow  counterpoise  tube.  When  the  lead  weights  are  on  the  coun- 
terpoise tube  the  bell  is  in  perfect  equilibrium  at  any  point  in  its 
course,  so  that  when  the  valve  C  (Fig.  6)  is  opened  to  room  air  the 
bell  will  not  change  its  position.  One  of  the  lead  weights  (the 
balancing  weight)  is  removable,  and  when  it  is  not  on  the  counter- 
poise tube  the  bell  will  gradually  drop  if  the  valve  C  is  opened  to 
room  air.  Whenever  readings  are  taken  of  the  volume  of  the 
gasometer  this  weight  must  be  on  the  counterpoise  tube.  For  the 
purpose  of  sampling,  however,  the  weight  is  removed  and  the  bell 
allowed  to  drop  by  opening  valve  C  until  about  half  the  volume  of 
air  collected  has  escaped,  thus  washing  the  sampling  connections 
with  the  expired  air.  An  extra  weight  (the  negative  pressure 
weight)  of  approximately  300  gm.  is  placed  on  the  counterpoise 
tube  after  the  preliminary  readings  are  taken  and  just  before  the 
test  is  started.  This  causes  a  slight  negative  pressure  between  the 
gasometer  and  the  patient  and  so  overcomes  the  resistance  of  the 
air  passing  through  tubes. 

The  position  of  the  bell  is  determined  by  means  of  two  fixed 
steel  pointers  reading  against  a  steel  tape  attached  to  the  counter- 


48  BASAL  METABOLIC   RATE 

poise  tube.  The  object  of  the  two  pointers  is  to  give  two  readings 
of  the  position  of  the  bell,  both  at  the  start  and  at  the  end  of  the 
test,  thus  giving  an  excellent  check  on  the  readings  of  the  difference 
in  the  position  of  the  bell  at  the  beginning  and  at  the  end  of  the 
experiment.  The  use  of  the  steel  tape  attached  to  the  counterpoise 
tube  for  reading  is  preferable  to  a  fixed  scale  with  a  movable  pointer 
attached  to  the  bell  itself  (as  is  the  arrangement  on  the  Tissot 
spirometer),  for  a  slight  swing  or  tip  of  the  bell  might  make  a  dis- 
tinct change  in  the  level  of  the  pointer,  and  consequently  result  in 
incorrect  reading  of  the  volume  of  air. 

To  obtain  the  temperature  of  the  air  in  the  bell  a  thermometer 
is  inserted  through  a  rubber  stopper  in  the  top  of  the  float.  The 
thermometer  projects  about  4  inches  inside  the  bell,  and  it  is  so 
placed  that  when  the  bell  is  completely  down  resting  on  the  top  of 
the  inner  copper  cylinder  the  thermometer  fits  into  the  air  inlet 
tube.  The  thermometer  is  graduated  to  one-fifth  of  a  degree  Cen- 
tigrade. 

Separate  outlet  and  inlet  tubes  are  arranged  on  the  gasometer 
as  indicated  in  Fig.  6.  The  valves  are  arranged  as  follows:  On 
the  inlet  tube  leading  from  the  patient  to  the  gasometer  there  is  a 
three-way  valve  which  when  set  in  position  B  closes  the  gasometer 
and  allows  the  expired  air  from  the  patient  to  escape  into  the  room ; 
when  set  in  position  A  the  former  opening  is  closed  and  the  expired 
air  passes  into  the  gasometer.  When  the  three-way  valve  on  the 
outlet  tube  is  put  in  position  C  the  gasometer  is  open  to  room  air; 
when  in  position  D,  the  gasometer  will  be  closed  if  the  sampling 
pet-cock  is  closed;  the  latter  is  open  only  while  taking  a  sample  of 
air.  On  the  portable  apparatus  a  two-way  valve  is  used  at  C  and 
the  sampling  pet-cock  is  inserted  directly  into  the  outlet  tube 
below  the  valve. 

The  water  seal  is  kept  at  the  level  indicated  in  Fig.  6.  It  never 
covers  the  incline  of  the  inner  cylinder,  consequently  the  expired 


CALIBRATION    OF    GASOMETER  49 

air  is  not  exposed  to  a  large  surface  of  water,  since  there  might  be 
an  appreciable  loss  of  carbon  dioxid  by  water  absorption.  The  level 
of  the  water  seal  drops  as  the  bell  rises ;  this  introduces  a  very  small 
and  negligible  error  in  the  readings.  The  water  in  the  tank  need 
be  changed  only  occasionally,  for  the  copper  salts  from  the  walls 
of  the  gasometer  prevent  bacterial  growth. 

To  test  the  bell  for  tightness  the  outlet  and  inlet  valves  are 
closed  with  the  bell  counterpoised.  The  bell  is  put  under  a  fairly 
heavy  positive  pressure  by  placing  a  weight  of  2  kg.  on  the  top  of  it. 
Readings  are  then  taken  of  the  gasometer  volume  and  its  tempera- 
ture, also  the  barometer  reading.  At  the  end  of  half  an  hour,  if 
no  changes  have  occurred  either  in  the  temperature  or  in  the  barom- 
eter, the  gasometer  volume  should  be  unchanged.  We  are  care- 
ful to  test  our  gasometers  frequently,  and  have  found  that  when- 
ever leaks  occurred  they  could  always  be  traced  to  faulty  greasing 
of  the  outlet  or  inlet  valves. 

6.  Barometer. — In  all  volumetric  work  with  gases  it  is  necessary 
to  reduce  the  observed  volume  of  the  gas  from  the  experimental 
temperature  and  pressure  to  the  standard  temperature  0°  C.  and 
the  standard  barometric  pressure  of  760  mm.  dry.     A  good  barom- 
eter,* such  as  supplied  to  the  United  States  Weather  Bureau  for 
ordinary  observatory  work,  is  necessary.     This  barometer  should 
have  a  metric  scale  with  a  vernier  reading  to  tenths  of  a  millimeter, 
and  a  thermometer  graduated  in  degrees  Centigrade. 

7.  Calibration  of  Gasometer. — The  gasometer  readings  are  made 
on  a  steel  tape,  fixed  on  the  counterpoise  tube.     The  tape  is  grad- 
uated to  0.10  cm.  and  is  read  by  means  of  stationary  markers  to 
0.05  cm.    It  is,  therefore,  necessary  to  determine  the  factor  of  the 
gasometer  in  order  to  convert  the  linear  rise  of  the  bell  into  a  unit 
of  volume.    This  factor  is  derived  in  the  following  manner:   The 

*A  suitable   barometer  may  be  obtained  from  Henry  J.  Green  Co.,  1911 
Bedford  Avenue,  Brooklyn.  N.  Y.,  Catalogue:  No.  1. 


50  BASAL  METABOLIC   RATE 

bell  of  the  gasometer  is  a  cylinder,  and  the  circumfeience  of  it  is 
determined  by  measurement  at  several  points  from  top  to  bottom, 
either  with  the  bell  in  position  or  removed  entirely  from  the  gas- 
ometer. On  our  gasometer  A  the  following  measurements  of  the 
circumference  were  taken  with  the  bell  in  position: 

Reading  on  tape,  Circumference  of  bell, 

cm.  cm. 

97 126.0 

87 126.0 

72 125.9 

59 125.9 

45 125.8 

33 125.8 

17 125.8 

9..  ..125.8 


Average. 125.9 

Since  the  radius  of  a  circle  =  ^~  X  the  circumference,  then  the 
radius  to  the  outside  of  the  wall  of  the  bell  =  2  *  U16  X  125.9 

=  20.038  cm.  The  radius  to  the  inside  of  the  bell  is,  therefore, 
equal  to  20.038  cm.  minus  the  thickness  of  the  copper  wall  as  de- 
termined by  calipers.  This  radius  of  the  inside  of  the  bell  is,  there- 
fore, 20.038  cm.  -  0.046  cm.  =  19.992  cm.  Since  the  area  of  a  circle 
equals  TtR2,  then  3.1416  X  19.9922  cm.  =  1256  sq.  cm.  Therefore, 
the  capacity  of  the  bell  corresponding  to  a  rise  of  1  cm.  measured 
by  the  tape  will  be  equal  to  1  cm.  X  1256  sq.  cm.  =  1256  c.c.  or 
1.256  1.,  the  factor  of  the  gasometer.  We  read  the  centimeter 
scale  to  the  nearest  half-millimeter  corresponding  to  a  change  in 
volume  of  63  c.c. 

8.  Collection  of  Expired  Air  in  Gasometer. — The  gasometer  bell 
is  dropped  to  the  bottom  of  the  tank  by  removing  the  balancing 
weight  and  opening  valve  C,  thus  forcing  out  all  the  air  save  what 
is  left  in  the  dead  space  at  the  top  of  the  tank  and  in  the  connecting 
pipes.  When  the  patient  has  rested  sufficiently  to  start  the  test, 
the  mask  is  tied  on  with  one  pair  of  tapes  around  the  upper  part  of 


COLLECTION    OF   EXPIRED   AIR    IN    GASOMETER  51 

the  mask  and  a  second  pair  over  the  chin.  One  of  the  assistants 
then  turns  the  gasometer  inlet  valve  so  that  the  expired  air  passes 
into  the  tank.  While  the  remaining  four  tapes  are  being  tied  the 
patient  is  filling  the  gasometer  and  the  connections  with  his  expired 
air.  When  the  gasometer  bell  has  risen  to  6  cm.  on  the  tape  the 
valve  C  (Fig.  6)  is  opened  and  the  bell  dropped  to  the  bottom  with- 
out turning  the  patient  off  from  the  machine.  Valve  C  is  then 
closed  and  the  gasometer  filled  with  expired  air  to  a  volume  corre- 
sponding to  3  cm.  on  the  tape.  Valve  B  is  then  turned  so  that  the 
patient  breathes  into  room  air.  Valve  C  is  opened  and  the  gas- 
ometer allowed  to  drop  to  about  1.50  on  the  tape,  so  that  a  small 
air  cushion  of  the  patient's  expired  air  is  left  at  the  top  of  the  inner 
tank.  The  bell  should  not  be  lowered  so  far  that  it  rests  on  the 
inner  copper  cylinder,  as  its  equilibrium  is  thereby  disturbed.  The 
balancing  weight  is  replaced  on  the  counterpoise  tube.  The  po- 
sition of  the  bell  at  the  start  of  the  test  is  taken  by  reading  the  level 
of  the  two  pointers  on  the  steel  tape.  These  readings  are  recorded 
to  the  nearest  0.05  cm.,  and  then  the  negative  pressure  weight 
is  added  to  the  counterpoise  tube.  The  inlet  valve  is  quickly 
turned,  so  that  the  patient  is  once  more  breathing  into  the 
gasometer,  and  at  the  same  instant  the  stop-watch  is  started  and 
the  time  independently  recorded  by  the  observer  sitting  with  the 
patient.  At  the  end  of  approximately  ten  minutes  the  inlet  valve 
is  turned  off  from  the  patient,  the  stop-watch  stopped,  and  the 
time  recorded  by  the  observer.  While  the  mask  is  removed  by 
the  observer,  the  other  assistant  removes  the  negative  pressure 
weight  from  the  counterpoise  tube,  makes  the  two  final  readings  on 
the  tape  to  the  nearest  0.05  cm.,  records  the  temperature  of  the 
gasometer  to  the  nearest  half-degree  Centigrade,  and  finally  the 
barometer  to  the  nearest  millimeter.  All  the  readings  mentioned 
are  checked  by  the  observer.  If  the  differences  in  the  two  sets  of 
readings  of  the  position  of  the  bell  at  the  beginning  and  at  the  end 


52  BASAL   METABOLIC   RATE 

of  the  experiment  do  not  agree,  the  test  is  repeated.  Likewise, 
if  the  duration  of  the  test  noted  by  the  observer  using  an  ordinary 
Ingersoll  watch  does  not  agree  within  five  seconds  of  the  time  on  the 
stop-watch,  the  test  is  repeated.  The  object  of  the  additional  time 
determination  by  the  observer  is  to  prevent  gross  misreadings  of 
the  stop-watch.  The  balancing  weight  on  the  counterpoise  tube  is 
then  taken  off  and  the  outlet  valve  C  and  sampling  pet-cock  opened 
to  room  air  to  wash  the  connections  with  the  expired  air.  The 
gasometer  is  allowed  to  drop  about  one-half  its  volume,  the  outlet 
valve  C  is  closed,  thus  shunting  the  air  current  through  the  open 
sampling  pet-cock  and  so  allowing  it  to  be  thoroughly  washed 
(Fig.  8).  At  the  end  of  one  minute  the  four  sampling  tubes  are 
filled  with  the  expired  air. 

9.  Sampling  Tubes. — The  sampling  tubes  (Figs.  8,  11)  are  those 
described  by  Krogh  and  Lindhard.  They  have  a  volume  of  30  or 
35  c.c.  with  a  two-way  tap  and  small  bored  tip  about  4  cm.  long  above 
the  tap  for  the  purpose  of  making  connections  with  the  gasometer  in 
sampling.  A  piece  of  rubber  tubing  about  15  inches  long  connects 
the  sampling  tube  to  its  mercury  reservoir  of  about  40  c.c.  capacity. 
The  sampling  tubes  are  mounted  in  fours  on  a  rack,  and  four  sam- 
ples of  expired  air  are  always  taken  for  each  test;  two  are  analyzed, 
and  this  leaves  two  extra  samples  in  case  of  accident.  The  sam- 
pling tubes  are  filled  to  the  tip  with  mercury.  In  sampling,  con- 
nection is  made  to  the  pet-cock  on  the  gasometer  by  means  of  heavy 
walled  3-mm.  bore  rubber  tubing.  The  tubing  is  tightly  adjusted 
to  the  tip  of  the  sampling  tube,  the  mercury  reservoir  lowered,  and 
the  tap  on  the  sampling  tube  opened.  The  sampling  tube  is  washed 
twice  with  the  expired  air  and  the  sample  collected  after  the  second 
rinsing.  The  tap  is  closed  and  the  mercury  reservoir  hung  up  to 
keep  the  sample  under  positive  pressure.  The  tap  must  be  well 
greased  and  for  this  purpose  we  use  a  "black  rubber"  grease,  the 
formula  for  which  is  given  on  page  81.  When  the  sampling  tubes 


STRATIFICATION    OF   AIR    IN    GASOMETER  53 

become  dirty  they  are  cleaned  with  concentrated  nitric  acid,  rinsed 
with  distilled  water,  and  thoroughly  dried.  This  is  sufficient  for 
the  purpose,  although  it  will  be  found  that  the  "etching"  that 
eventually  develops  on  the  inside  of  the  tubes  cannot  be  removed. 

10.  Stratification  of  Air  in  Gasometer. — On  account  of  the  well- 
known  tendency  of  air  to  stratify  and,  therefore,  not  form  a  uni- 
form mixture  throughout,  doubt  has  often  been  expressed  as  to 
the  possible  variation  of  the  percentages  of  carbon  dioxid  and  oxy- 
gen at  different  levels  in  the  gasometer.  Carpenter  reviewed  the 
existing  evidence  on  this  point  and,  in  addition,  published  a  few 
new  experiments.  He  concluded  that  the  "uniformity  in  the  com- 
position of  the  air  throughout  the  spirometer  depends  on  the  char- 
acter of  the  respiration.  .  .  .  When  the  respiration  was  quiet 
and  uniform  the  good  agreement  of  the  results  indicates  that  the 
composition  of  the  expired  air  was  uniform  in  all  parts  of  the  spi- 
rometer." 

As  the  accuracy  of  the  gasometer  method  depends  fundamen- 
tally on  obtaining  samples  of  expired  air  from  the  gasometer  that 
represent  at  least  with  a  negligible  error  the  mean  composition  of 
the  expired  air,  we  have  investigated  the  question  of  stratification 
in  considerable  detail.  The  method  of  procedure  was  as  follows: 
Samples  were  taken  from  the  gasometer  according  to  the  usual 
routine  described  on  page  50,  with  the  exception  that  in  addition 
to  the  regular  sample  taken  from  the  middle  of  the  gasometer  two 
additional  samples  were  taken,  the  one  after  the  bell  had  been 
allowed  to  drop  10  cm.  from  the  top,  and  the  other  after  the  bell 
had  been  dropped  to  within  10  cm.  of  the  bottom.  This  gave  three 
sets  of  samples  of  air  collected  first  from  the  lower  segment  of  the 
gasometer,  second  from  the  middle  segment,  and  third  from  the 
top  segment.  Analyses  were  made  in  duplicate  according  to  our 
usual  custom.  Forty-nine  experiments  were  done,  in  14  of  which 
no  note  was  made  of  the  length  of  time  elapsing  between  the  collec- 


54 


BASAL   METABOLIC   RATE 


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COMPOSITION   OF   AIR   IN   GASOMETER  55 

tion  of  the  expired  air  and  the  sampling;  in  10,  samples  were  taken 
as  soon  as  possible  after  the  collection  of  the  expired  air ;  in  11,  they 
were  taken  after  a  lapse  of  five  minutes,  and  in  14,  after  a  lapse  of 
ten  minutes. 

A  study  of  the  experiments  summarized  in  Table  6  shows  that 
the  expired  air  collected  in  a  gasometer  has  a  tendency  to  stratify. 
However,  if  the  samples  used  for  calculating  the  metabolic  rate 
are  taken  from  the  middle  of  the  gasometer,  the  error  caused 
by  such  stratification  is  negligible,  especially  if  a  few  minutes  are 
allowed  to  elapse  between  the  collection  of  the  expired  air  and  the 
taking  of  the  samples  in  order  that  the  gas  mixture  may  become 
more  uniform  by  diffusion.  Furthermore,  the  cases  given  in  Table 
6  were  taken  indiscriminately  and,  therefore,  represent  with 
reasonable  probability  the  usual  variations  in  the  type  of  respira- 
tion that  one  naturally  meets  in  the  course  of  routine  work.  We 
conclude,  therefore,  that  the  accidental  error  that  might  be  intro- 
duced by  the  slight  stratification  that  exists  in  the  expired  air  col- 
lected in  a  gasometer  does  not  invalidate  the  calculation  of  the 
metabolic  rate,  since  such  changes  that  are  thereby  produced 
fall  within  the  total  experimental  error  of  the  method. 

11.  Effect  on  the  Carbon  Dioxid  and  Oxygen  Content  of  the 
Expired  Air  from  Standing  in  the  Gasometer. — It  was  likewise  im- 
portant to  know  whether  or  not  variations  in  the  carbon  dioxid  and 
oxygen  content  of  expired  air  collected  in  a  gasometer  changed  after 
prolonged  standing,  as  theoretically  it  might  be  thought  that  the 
water  seal  of  the  gasometer  might  either  take  up  or  give  off  carbon 
dioxid.  Therefore,  we  carried  out  22  experiments  in  which  three 
hours  elapsed  between  the  collection  of  the  first  and  second  samples. 
A  second  set  of  16  experiments  was  done  in  which  the  samples  were 
collected  the  next  morning,  about  twenty  hours  after  the  collection 
of  the  first  sample.  All  of  the  analyses  were  done  in  duplicate, 
according  to  our  usual  routine.  The  results  are  summarized  in 


BASAL  METABOLIC   RATE 


TABLE  7%   EFFECT  ON  THE  C02  AND  02  CONTENT  OF  EXPIRED  AIR  FROM 


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Table  7,  and  show  but  a  negligible  change  in  the  percentages  of 
carbon  dioxid  and  oxygen  from  standing  twenty  hours  in  this  type 
of  gasometer. 

C.  THE  HALDANE  GAS  ANALYSIS  APPARATUS 
1.  Description  of  Haldane  Apparatus. — The  analyses  are  done 
in  a  portable  Haldane  gas  analysis  apparatus  (Figs.  10,  11,  12),  de- 
scribed very  fully  by  Haldane  in  his  book  on  Air  Analysis.  Briefly, 
a  sample  of  air  is  taken  into  the  buret  and  its  volume  measured;  the 
air  is  passed  back  and  forth  into  the  tube  containing  potash  solu- 
tion to  absorb  the  carbon  dioxid  and  then  a  second  reading  of  the 
volume  made.  The  contraction  in  volume  of  the  sample,  due  to 
absorption  of  carbon  dioxid  by  the  potash  solution,  divided  by  the 
original  volume  of  the  sample,  is  the  percentage  of  carbon  dioxid 
present  in  the  dry  sample  of  air.  In  like  manner  the  percentage  of 
oxygen  is  determined  by  absorbing  the  oxygen  in  potassium  pyro- 
gallate  solution  and  measuring  the  contraction  in  the  volume  of  the 
air  sample. 

The  general  arrangement  of  the  apparatus  is  shown  in  Figs.  11, 
12.  It  consists  of  a  calibrated  buret  (2)  of  10  c.c.  volume,  a  control 
tube  (3)  of  approximately  the  same  volume  as  the  buret,  both  sur- 
rounded by  a  water-bath  (1),  and  two  absorption  pipets  of  about 
30  c.c.  capacity,  the  one  containing  potash  (16)  for  carbon  dioxid 


DESCRIPTION    OF    HALDANE    APPARATUS 


57 


absorption  and  the  other  potassium  pyrogallate  (21)  for  oxygen 
absorption.    In  addition,  there  are  three  three-way  taps  to  connect 


1 


the  various  parts  of  the  apparatus.    One  tap  (14)  connects  the  buret 
with  either  the  potash  (16)  or  the  pyro  absorption  pipet  (21).    An- 


BASAL  METABOLIC   RATE 


other  tap  (18)  is  used  to  connect  the  control  tube  with  the  potash 
manometer  tube  (25)  or  with  room  air.    The  third  tap  (19)  is  placed 


Fig.  11. — Detail  of  Haldane  apparatus. 

above  the  pyro  absorption  pipet  and,  while  not  necessary,  is  con- 
venient when  cleaning  the  apparatus.    On  all  the  three-way  taps  a 


DESCRIPTION    OF    HALDANE    APPARATUS  59 


-7 


Fig.  12. — 1.  Water-bath.  2.  Buret.  3.  Control  tube.  4.  Glazed  glass  in 
back  of  water-bath.  5.  Pressure  tubing  connecting  buret  and  its  mercury  reser- 
voir. 6.  Mercury  reservoir.  7.  Ratchet  and  pinion.  8.  Buret  tap.  9.  Sam- 
pling tap.  10.  Sampling  connection.  11.  Two-way  tap  on  sampling  tube.  12. 
Sampling  tube.  13.  Sampling  tube  reservoir.  14.  Potash  tap.  15.  Level  mark- 
ing on  potash  pipet.  16.  Potash  pipet.  17.  Potash  reservoir.  18.  Control  tube 
tap.  19.  Pyro  tap.  20.  Level  marking  on  pyro  pipet.  21.  Pyro  pipet.  22. 
Buret  corrections.  23.  Magnifying  lens.  24.  Switch  for  electric  light  back  of 
Haldane  board.  25.  Level  marking  on  manometer  tube.  26.  Hook  upon  which 
to  hang  mercury  reservoir  for  shaking.  27.  Shafting  going  around  room  to  raise 
and  lower  28.  28.  Arm  from  shafting.  29.  Seal  tube.  30.  Solid  glass  rod  for 
closing  pyro  filling  connection.  31.  Tube  for  compressed  air  to  stir  water-bath. 


60  BASAL   METABOLIC   RATE 

drop  of  sealing-wax  is  put  on  the  handle  to  indicate  the  position  of 
the  short  arm.  All  of  the  taps  must  be  air-tight,  fitting  the  bore 
perfectly,  so  that  they  turn  without  binding  or  making  striations. 
Finally,  there  are  the  potash  (17)  and  mercury  (6)  reservoirs  and 
beyond  the  pyro  tube  a  seal  tube  (29)  partly  filled  with  dilute 
potash  solution  to  prevent  the  pyro  from  coming  in  contact  with 
room  air.  The  various  parts  of  the  Haldane  are  shipped  dismounted 
and  the  buret  has  an  extra  tap  fused  on  it  to  facilitate  the  cali- 
bration. 

2.  Calibration  of  the  Haldane  Buret. — To  obtain  accuracy  in 
gas  analysis  it  is  necessary  to  calibrate  the  buret  carefully  because 
the  glass  maker  may  neglect  to  take  into  consideration  the  volume 
of  the  openings  in  the  tap;  assume  that  the  buret  has  an  abso- 
lutely even  bore;  carry  out  the  calibration  with  the  buret  upside 
down,  or  he  may  make  some  other  gross  error.  In  calibrating,  the 
buret  is  filled  with  mercury  and  the  weights  of  the  mercury  corres- 
ponding to  various  volumetric  readings  on  the  buret  are  determined. 
Since  the  volume  (V)  of  a  liquid  is  equal  to  its  weight  (W)  divided  by 
its  density  (D)  the  corresponding  volumes  of  the  various  weights 
of  mercury  are  determined.  The  volume  of  the  mercury  thus  cal- 
culated is  compared  with  the  corresponding  volumetric  readings 
on  the  buret  and  the  correction  determined. 

The  buret  is  first  thoroughly  cleaned  with  warm  cleaning  solu- 
tion, then  rinsed  with  distilled  water,  and  completely  dried  by 
sucking  clean  air  through  it.  The  clean,  dry  buret  is  filled  through 
the  calibration  tap  with  mercury  up  to  and  just  within  the  buret 
tap.  A  convenient  way  of  doing  this  is  by  suction  or  by  attaching 
rubber  tubing  with  a  mercury  reservoir  to  the  lower  end  of  the 
buret.  It  is  important  that  no  air  bubbles  are  caught  by  the  mer- 
cury. When  the  mercury  completely  fills  the  buret  and  is  just 
within  the  buret  tap  the  calibration  tap  is  closed  and  the  buret  tap 
is  quickly  turned,  cutting  off  the  head  of  the  mercury  column  and 


CALIBRATION    OF    THE   HALDANE    BURET  6 1 

immediately  withdrawn  from  its  bore,  care  being  taken  not  to  leave 
behind  in  the  bore  any  of  the  minute  particles  of  mercury  from  the 
tap.  In  this  way  the  buret  is  accurately  filled  with  mercury.  The 
calibration  and  buret  taps  must  never  be  left  closed  with  the  buret 
filled  with  mercury  because  the  expansion  of  the  mercury  with 
the  rise  of  room  temperature  will  burst  the  buret.  The  mercury 
is  run  slowly  down,  approximately  to  the  reading  7.0  cm.,  and  is 
collected  in  a  dry  and  clean,  weighed  dish.  After  gently  tapping 
the  buret  with  a  pencil,  the  accurate  reading  of  the  volume  of  mer- 
cury in  the  buret  to  0.001  c.c.  is  recorded  and  the  total  weight  to 
the  nearest  0.001  gm.  of  the  mercury  and  dish  found.  Care  should 
be  taken  that  no  particles  of  mercury  cling  to  the  inside  of  the  buret 
.as  the  mercury  runs  out.  This  usually  means  that  the  buret  is 
greasy  and  should  be  recleaned.  The  surface  of  the  mercury  in  the 
weighing  dish  should  be  brought  into  contact  with  the  surface  of 
the  mercury  at  the  end  of  the  calibration  tap,  so  that  a  constant 
amount  of  mercury  is  left  in  the  end  of  the  buret  after  each  portion 
of  mercury  is  collected.  The  weighing  should  be  done  on  a  fine 
chemical  balance  and  recorded  to  the  nearest  0.001  gm. 

Before  weighing  the  mercury  the  reading  of  the  buret  should 
be  recorded  to  the  nearest  0.001  c.c.  The  reading  of  the  buret  is 
difficult;  it  requires  great  care  and  may  be  affected  by  numerous 
factors.  It  seems  worth  while  to  enumerate  them  in  detail.  To 
obtain  correct  readings  the  buret  must  be  set  up  during  the  cali- 
bration so  that  it  is  perpendicular.  A  thermometer  should  be  hung 
near  the  buret  and  the  temperature  noted  from  time  to  time.  Va- 
riations in  the  temperature  affect  the  buret  readings,  a  fluctuation 
of  one  degree  causing  a  change  in  a  volume  of  7  c.c.  of  mercury  of 
approximately  0.001  c.c.  The  room  in  which  the  calibration  is 
being  carried  out  should,  therefore,  be  kept  at  as  constant  a  tem- 
perature as  possible  and  drafts  avoided.  Likewise  care  must  be 
taken  not  to  breathe  on  the  buret  or  to  touch  it  with  the  hands  dur- 


62  BASAL  METABOLIC   RATE 

ing  the  calibration.  The  buret  should  be  gently  tapped  with  a 
pencil  before  the  reading  is  taken  to  obtain  a  true  meniscus  of  the 
mercury.  The  reading  lens  should  be  held  parallel  with  the  buret 
with  the  center  of  the  lens  opposite  the  mercury  meniscus.  The 
eyes  must  be  on  the  correct  level  before  making  a  reading  of  the 
mercury  meniscus.  To  do  this  the  reflections  on  the  mercury  of 
the  two  0.01  c.c.  markings  on  the  buret  just  below  the  mercury 
meniscus  are  located  and  the  eyes  are  on  the  correct  level  when 
these  two  lines  and  their  reflections  exactly  coincide. 

The  weights  of  successive  portions  of  the  mercury  are  found  for 
various  readings  of  the  buret — approximately  at  7.0  c.c.,  7.3  c.c.,  7.5 
c.c.,  8.0  c.c.,  8.5  c.c.,  9.0  c.c.,  9.2  c.c.,  9.4  c.c.,  9.6  c.c.,  and  at  9.99  c.c. 
The  calibration  is  then  repeated,  without  cleaning  the  buret,  de- 
termining the  weights  of  mercury  at  the  readings,  7.0  c.c.,  7.5  c.c., 
8.0  c.c.,  9.0  c.c.,  9.5  c.c.,  and  9.99  c.c.  It  is  preferable  to  do  the 
two  calibrations  at  one  sitting  and  the  corrections  should  check 
within  ±0.001  c.c. 

We  do  not  determine  the  volume  of  the  tap  by  mercury  because 
it  is  practically  impossible  to  fill  the  arms  completely  with  mercury. 
It  is  much  more  accurate  to  measure  the  lengths  and  diameters  of 
the  arms  of  the  tap  by  using  calipers  and  to  calculate  the  volume. 
The  openings  in  the  tap  are  in  the  form  of  a  T.  On  our  buret  K 
the  length  of  the  longer  arm  is  8.4  mm.  and  of  the  short  arm  4.3 
mm.,  and  the  diameter  of  both  arms  is  2.5  mm.  Since  the  volume 
of  the  tap  equals  the  length  of  the  arms  multiplied  by  TiR2,  then 
(8.4  mm.  +  4.3  mm.)  X  (-^ -)2  X  3.1416  =  62.0  cu.  mm.  = 
0.062  c.c.,  which  is  the  volume  of  the  tap. 

Instead  of  using  the  absolute  density  of  the  mercury  correspond- 
ing to  the  temperature  recorded  by  the  thermometer  near  the  buret, 
we  calculate  the  comparative  density  of  the  mercury  from  the  ex- 
perimental data.  In  calibrating  buret  K  at  the  reading  9.999 
c.c.  the  weight  of  the  mercury  was  135.127  gm.,  its  density  is,  there- 


CALIBRATION    OF    THE   HALDANE    BURET  63 

fore,  13959997/cm  =  13.514.  Converting  the  volume  of  the  tap  into 
the  corresponding  weight  of  mercury,  0.062  c.c.  X  13.514  =  0.843 
gm.  Therefore,  the  total  weight  of  the  mercury  in  the  stem  and  in 
the  buret  tap  (had  the  tap  been  in  place  and  filled  with  mercury) 
at  the  reading  9.999  c.c.  would  be  equal  to  135.127  gm.  +  0.843  gm. 

=  135.970  gm.,  and  the  final  density  of  mercury  as  determined  ex- 
perimentally would  therefore  be  135.970  gm.  -5-  9.999  c.c.  =  13.598. 
The  calculated  weight  of  mercury  in  the  tap  added  to  the  weight 
of  mercury  corresponding  to  the  volume  of  the  buret  at  7.003  c.c. 
equals  95.259  gm.  +  0.843  gm.  =  96.102  gm.  The  true  volume  of 
the  mercury  corresponding  to  the  buret  volume  of  7.003  c.c.  is 
96.102  gm.  -T-  13.598  =  7.067  c.c.  That  is,  the  buret  at  this  point 
has  an  actual  volume  larger  than  the  volume  read  by  7.067  c.c. 

-  7.003  c.c.  =  0.064  c.c.  The  correction  at  the  reading  7.003  c.c. 
on  the  buret  is,  therefore, +0.064.  In  Table  8  is  given  the  calibra- 
tion of  four  points  on  buret  K. 

When  the  corrections  for  the  various  readings  are  determined 
as  above  they  are  plotted  on  millimeter  paper  and  the  corrections 
for  each  0.1  c.c.  reading  of  the  buret  are  read  off  from  the  curve  and 
listed  for  use.  As  stated  above,  duplicate  calibrations  are  done  and 
care  is  taken  in  both  determinations  to  obtain  the  weight  of  mercury 
at  practically  the  same  final  reading,  9.99  c.c.,  in  order  to  obtain 
agreement  in  the  calculated  density  of  the  mercury.  This  method 
gives  a  zero  correction  at  the  reading  9.99  c.c.,  thus  adopting  this 
value  as  the  "unit"  of  the  buret;  it  is  unnecessary  in  this  type  of 
apparatus  to  calibrate  the  buret  in  terms  of  a  standard  cubic  centi- 
meter as  the  unit.  Consequently,  in  case  any  or  all  of  the  correc- 
tions are  found  to  be  minus  it  is  desirable  to  recalculate  the  cali- 
bration, deliberately  selecting  a  density  of  mercury  that  will  give  a 
zero  correction  for  the  largest  negative  correction  found  by  the  first 
calculation;  if  this  is  done  all  the  other  corrections  will  be  plus,  which 
is  a  great  advantage  when  calculating  the  results. 


64 


BASAL   METABOLIC   RATE 


Haldane  carries  out  the  calibration  with  the  sides  of  the  buret 
moistened  with  water  just  as  it  is  actually  used.     The  viaration  in 


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the  moisture  makes  it  somewhat  difficult  to  obtain  check  calibra- 
tions, and  so  we  prefer  to  calibrate  the  buret  dry.     The  calibration 


ASSEMBLING    THE    HALDANE  65 

tap  must  be  fused  to  the  buret  and  not  attached  by  rubber  tubing, 
because  changes  in  level  of  the  mercury  from  the  top  to  the  bottom 
of  the  buret  will  produce  variations  in  pressure  against  the  rubber 
tubing,  and  consequently  the  latter  will  not  always  have  the  same 
bore,  and  an  appreciable  error  in  the  calibration  results.  As  has 
been  suggested  by  Haldane,  it  is  possible  to  calibrate  the  gas  analysis 
apparatus  by  determining  the  percentage  error  found  on  analyz- 
ing pure  outdoor  air  which  has  a  constant  composition  of  carbon 
dioxid  and  oxygen.  This  method  is  only  applicable  if  the  buret 
has  an  absolutely  even  bore  throughout  its  entire  length,  and  we 
have  found  this  frequently  not  to  be  the  case. 

3.  Assembling  the  Haldane. — The  mounting  of  the  various  parts 
of  the  Haldane  is  not  difficult.  If  the  duplicate  calibrations  agree 
the  calibration  tap  is  cut  off  and  the  end  of  the  buret  carefully  fire- 
polished.  To  clearly  define  the  graduations  of  the  buret,  the  stem 
is  cautiously  warmed  over  a  low  flame  and  a  blue  skin  pencil  rubbed 
hard  over  the  surface  of  the  buret  to  fill  in  the  figures  and  markings 
with  "the  blue  lead;  the  excess  is  wiped  off  with  a  soft  cloth.  The 
length  of  the  water-bath  (1)  is  cut  so  that  it  will  reach  from  just 
below  the  buret  tap  (8)  to  about  5  cm.  below  the  10  c.c.  mark  on 
the  buret.  The  control  tube  should  fit  in  the  water-bath  with  its 
bulb  1  cm.  below  the  bulb  of  the  buret.  A  right-angle  bend  is  made 
in  the  control  tube  about  2.5  cm.  above  the  buret  tap  (8).  The  end 
of  the  control  tube  is  sealed  at  a  point  projecting  2  cm.  below  the 
water-bath  and  it  is  then  filled  about  half-way  up  its  stem  with  dis- 
tilled water.  By  means  of  a  sharp  cork  borer,  moistened  with  soap 
solution,  two  holes  are  bored  in  a  rubber  stopper  which  should  not 
be  more  than  1.5  cm.  thick.  The  stopper  is  fitted  into  one  end  of 
the  water-bath  and  the  control  tube  and  buret  are  put  inside  the 
water-bath  and  through  the  stopper.  The  rubber  tubing  (5),  after 
being  thoroughly  cleaned  of  talc  and  moistened  with  water,  is  slipped 
on  the  buret.  The  water-bath,  with  the  buret  and  control  tube  in 

5 


66  BASAL   METABOLIC   RATE 

position,  is  placed  on  the  Haldane  board  in  front  of  the  glazed  glass 
(4)  and  is  supported  by  two  long  screws.  It  is  securely  held  in  place 
by  wires,  covered  with  rubber  tubing,  across  the  top  and  bottom  of 
the  water-bath.  One  by  one  the  taps  and  pipets  are  measured, 
cut  off  to  the  proper  lengths,  fire-polished,  and  mounted  with  proper 
rubber  connections.  For  this  purpose  heavy  3  mm.  bore  pressure 
tubing  is  used,  except  on  the  lower  part  of  the  potash  (16)  and  pyro 
(21)  pipets  where  black  sulphid-free  tubing  is  necessary.  The 
pressure  tubing  must  be  thoroughly  cleaned  of  its  talc.  A  piece  of 
tubing  (10)  of  1  mm.  bore  and  30  cm.  long,  connected  at  each  end 
by  1  mm.  bore  glass  tubing  to  two  pieces  of  the  3  mm.  bore  pressure 
tubing,  is  attached  at  one  end  to  the  arm  of  the  sampling  tap  (9). 
Finally,  the  various  parts  are  supported  by  appropriately  placed 
2-inch  screws,  covered  with  rubber  tubing,  and  held  firmly  by 
copper  wire  covered  with  rubber  tubing.  The  taps  must  not  be 
allowed  to  rest  on  or  press  against  the  Haldane  board,  as  they  are 
thereby  loosened  from  their  bores,  causing  them  to  leak.  Care 
should  be  taken  not  to  fasten  the  glass  parts  too  rigidly,  as  with 
changes  in  temperature  the  glass  may  break.  In  case  the  level 
markings  are  not  cut  into  the  glass  on  the  potash  and  pyro  pipets 
and  manometer  tube  a  linen  thread  may  be  tightly  tied  on  and  held 
in  place  by  a  tiny  drop  of  glue  on  either  side.  The  line  drawings 
and  photographs  (Figs.  11,  12)  indicate  quite  accurately  the  gen- 
eral set  up  and  position  of  the  supporting  screws,  clamps,  and  so 
forth. 

A  convenient  way  of  cutting  glass  tubing  the  size  of  the  water- 
bath  or  even  larger  is  to  use  an  electric  glass  cutter  (Fig.  13).  It 
consists  of  2  or  3  feet  of  nichrome  or  chromel  wire  (No.  22  or  24, 
B.  &  S.)  supported  by  three  or  four  2-inch  screws  as  binding-posts 
on  an  asbestos  board.  To  the  binding-post  at  one  end  is  attached 
one  of  the  wires  from  an  ordinary  electric  circuit;  to  the  binding- 
post  at  the  other  end  is  fastened  another  piece  of  nichrome  wire 


ELECTRIC   GLASS   CUTTER  67 

about  18  inches  long  to  the  free  end  of  which  is  attached  an  ordi- 
nary thumb  snap  switch  which  is  connected  with  the  other  in- 
sulated wire  from  the  electric'circuit.  When  the  current  is  on  the 


Fig.  13. — Electric  glass  cutter. 

wire  should  become  red  hot,  but  should  not  reach  a  white  heat; 
the  proper  degree  of  heating  is  regulated  by  varying  the  length  of 
the  nichrome  wire  between  the  binding-posts.  A  single  deep  cut 


68  BASAL  METABOLIC   RATE 

is  made  on  the  glass  tubing  with  a  sharp  triangle  file  and  the  ni- 
chrome  wire  is  passed  through  this  cut  and  around  the  tube.  The 
wire  must  be  kept  taut  and  no  short  circuit  made  by  contact  be- 
tween the  loops  of  wire.  The  switch,  which  acts  as  a  handle,  is 
pressed  with  the  thumb,  the  wire  becomes  red  hot,  and  expands. 
It  is  necessary,  therefore,  to  keep  sufficient  tension  on  the  wire  to 
take  up  the  slack.  After  thirty  to  sixty  seconds  the  tube  will  crack 
off  evenly.  With  very  hard  glass  it  may  be  occasionally  necessary 
to  turn  off  the  electricity  and  dash  on  a  glass  of  cold  water. 

4.  Control  Tube. — By  means  of  the  control  tube,  first  employed 
in  gas  analysis  by  Williamson  and  Russell  in  1868,  the  effects  of 
changes  in  temperature,  pressure,  and  water  vapor  on  the  gas 
volume  may  be  compensated.  The  control  tube  (3)  has  approxi- 
mately the  same  shape  and  volume  as  the  gas  buret;  it  is  sealed  at 
the  lower  end  and  filled  about  half-way  up  its  stem  with  distilled 
water.  It  is  placed  in  the  water-bath  beside  the  buret  and  the 
pressure  of  the  air  within  is  balanced  against  that  in  the  buret 
through  the  potash  absorption  pipet  (16),  the  potash  tube  (25) 
acting  as  a  manometer.  A  three-way  tap  (18)  on  the  control  tube 
permits  connection  with  the  room  air,  so  that  before  an  analysis 
the  pressure  in  the  control  tube  may  be  made  the  same  as  that  in 
the  room.  Since  the  control  tube  is  in  the  water-bath  (1)  beside  the 
buret  any  changes  in  pressure  or  temperature  will  affect  alike  the  air 
in  both  the  buret  and  the  control  tube,  and  their  effect  on  the  air 
in  the  buret  can  be  compensated  by  altering  the  level  of  the  potash 
reservoir  (17)  and  the  mercury  reservoir  (6)  to  bring  the  potash  to 
the  standard  level  in  the  manometer  (25)  and  in  the  potash  pipet 
(15),  thereby  maintaining  the  volume  of  air  in  the  control  tube  con- 
stant and  the  pressure  in  the  control  tube  and  buret  alike.  There- 
fore the  readings  of  the  buret  are  compensated  by  mechanical 
means  for  variations  of  temperature  and  barometric  pressure  dur- 
ing the  analysis. 


MANAGEMENT    OF    HALDANE   APPARATUS  69 

5.  Management  of  Haldane  Apparatus. — (a)  Preliminary. — 
Compressed  air  is  slowly  bubbled  through  the  water-bath  (1)  in 
which  the  buret  (2)  and  control  tube  (3)  are  mounted  to  keep  the 
water  constantly  stirred  and  thus  maintain  the  entire  column  of 
water  at  a  uniform  temperature.  As  a  result  the  air  in  both  the  con- 
trol tube  and  the  buret  has  the  same  temperature.  Instead  of  hav- 
ing a  constant  stream  of  compressed  air  circulating  through  the 
water-bath  the  water  can  be  stirred  just  before  any  of  the  readings 
on  the  buret  are  made  by  using  a  blood-pressure  bulb  attached  to 
the  tube  leading  into  the  water-bath.  Before  the  machine  is  ready 
for  an  analysis  it  must  be  checked  to  see  that  it  is  air-tight  and  that 
there  is  no  carbon  dioxid  or  oxygen  in  the  buret.  For  this  the  fol- 
lowing procedure  is  necessary:  The  buret  tap  (8)  and  the  potash 
tap  (14)  are  turned  so  that  the  buret  is  closed  to  room  air  and  is  in 
connection  with  the  potash  pipet  (16).  With  the  control  tap  (18) 
open  to  room  air  and  in  connection  with  the  potash  manometer  (25) 
and  the  control  tube  (3)  the  levels  of  the  potash  in  the  absorbing 
pipet  (15)  and  in  the  manometer  tube  (25)  are  set  at  the  levels 
marked  thereon.  The  control  tap  (18)  is  closed  to  room  air.  The 
air  in  the  buret  is  shunted  into  the  pyro  (21)  by  properly  turning 
the  tap  (14)  and  by  raising  the  mercury  reservoir  (6)  attached  to 
the  buret.  After  passing  back  and  forth  in  the  pyro  ten  times,  the 
air  is  shunted  into  the  potash  pipet  in  order  to  remove  all  traces  of 
oxygen  by  bringing  the  air  above  the  potash  level  to  the  same  com- 
position as  the  air  in  the  buret.  This  procedure  is  called  "washing 
or  rinsing"  the  connections.  After  rinsing  in  the  potash  twice  the 
air  is  then  passed  back  and  forth  in  the  pyro  ten  times.  This  pro- 
cedure, rinsing  in  the  potash  and  absorption  in  the  pyro,  is  repeated 
three  times.  The  preliminary  nitrogen  reading  can  now  be  taken. 
To  do  this  the  pyro  is  brought  to  the  level  (20),  and  when  carefully 
adjusted  the  tap  (14)  is  turned  so  that  the  air  in  the  buret  is  in  con- 
nection with  the  potash  solution  only.  The  levels  in  the  potash 


70  BASAL  METABOLIC   RATE 

(15)  and  manometer  (25)  tubes  are  now  set,  using  the  potash  (17) 
and  mercury  (6)  reservoirs  for  this.  The  potash  reservoir  is  ad- 
justed by  sliding  through  its  spring  clamp  and  the  mercury  reser- 
voir by  means  of  a  ratchet  and  pinion  (7).  The  reading  of  the 
mercury  meniscus  is  then  made  with  all  the  precautions  mentioned 
on  page  61 :  to  hold  the  lens  properly  and  to  have  the  eyes  on  the 
correct  level  and  the  various  levels  carefully  adjusted.  The  volume 
is  recorded  to  the  nearest  0.001  c.c.  An  electric  light  (with  a  12- 
inch  Mazda  Fostoria  bulb)  placed  behind  the  Haldane  is  turned  on 
by  the  switch  (24);  the  light  shining  through  the  glazed  glass  (4) 
sharply  defines  the  mercury  meniscus  so  that  accurate  readings  are 
quickly  obtained.  The  light  is  immediately  turned  off  when  the 
reading  has  been  made.  The  potash  tube  is  again  washed  twice  and 
the  air  then  shunted  into  the  pyro,  and,  after  passing  back  and  forth 
ten  times,  the  reading  of  the  volume  is  again  determined,  setting 
the  various  levels  described  above.  If  the  machine  had  been  left 
full  of  nitrogen  from  the  previous  analysis  these  nitrogen  readings 
should  now  check.  If  the  readings  do  not  check  within  0.002  c.c., 
the  process  above  is  repeated  until  check  readings  of  the  volume 
are  obtained,  after  which  the  machine  is  ready  for  an  analysis. 

(b)  Sampling. — Connection  is  made  by  a  1-mm.  bore  rubber 
tubing  (10)  from  the  sampling  tap  (9)  to  the  sampling  tube  (12). 
The  tap  (11)  on  the  sampling  tube  is  opened,  care  being  taken  that 
the  sampling  tap  (9)  is  closed  so  that  none  of  the  sample  can  escape. 
The  potash  and  pyro  levels  are  carefully  set  and  the  buret  tap  is 
closed  to  the  potash  and  opened  to  room  air.  At  this  point  in  the 
procedure  acidified  water  is  put  in  the  buret  with  a  medicine-dropper 
if  it  appears  dry,  for  the  air  sample  must  be  thoroughly  saturated 
with  water  vapor  throughout  the  analysis.  For  this  purpose  dis- 
tilled water  slightly  acidified  with  sulphuric  acid  is  used  (about 
2  drops  of  concentrated  sulphuric  acid  in  50  c.c.  of  distilled  water). 
It  is  most  important  to  have  sufficient  water  in  the  buret,  enough 


MANAGEMENT    OF    HALDANE    APPARATUS  71 

so  that  the  inside  appears  moist  and  there  is  a  very  small  amount 
on  the  mercury  meniscus.  If  the  buret  is  too  dry,  readings  simulat- 
ing a  leak  in  the  machine  will  be  obtained  because  of  the  variation 
in  saturation  of  the  air  sample  with  water  vapor.  The  buret  is 
washed  twice  with  room  air,  thus  diluting  the  nitrogen  and  bring- 
ing the  air  in  the  buret  more  nearly  to  the  composition  of  the 
sample  to  be  analyzed.  The  index-finger  of  the  left  hand  is  moist- 
ened with  water  and  placed  on  the  top  of  the  buret,  and  with 
the  right  hand  holding  the  mercury  reservoir  (6),  and  securely  sup- 
ported on  the  upper  edge  of  the  Haldane  board,  the  mercury  in  the 
buret  is  brought  up  to  the  buret  tap  (not  into  it),  the  air  is  allowed 
to  escape  slowly  from  beneath  the  index-finger,  and  then  the  sampling 
may  be  started.  The  sampling  tap  (9)  is  cautiously  turned  by  the 
thumb  and  middle  finger  of  the  left  hand  to  the  sampling  tube  (12) 
and  buret  (2),  and,  since  the  sample  is  under  positive  pressure,  it 
will  run  into  the  buret.  When  3  c.c.  of  the  sample  have  passed  into 
the  buret  the  sampling  tap  (9)  is  turned  off  from  the  sampling  tube 
(12)  and  the  air  in  the  buret  is  permitted  to  escape  into  the  room 
by  cautiously  allowing  it  to  flow  from  under  the  moistened  index- 
finger  in  position  on  the  top  of  the  buret.  The  air  escapes  until 
the  mercury  in  the  buret  has  reached  the  buret  tap  (8) .  This  process 
must  be  carried  out  slowly  so  that  there  is  no  back  lash  of  the  mer- 
cury which  might  introduce  room  air  into  the  buret  and  so  vitiate 
the  sample.  This  is  the  first  rinsing.  Three  subsequent  rinsings 
of  about  3  c.c.  each  are  cautiously  and  carefully  made  without  re- 
moving the  index-finger  of  the  left  hand  from  its  position  at  the  top 
of  the  buret,  and  then  the  sampling  tap  (9)  is  completely  opened  to 
the  buret  and  sampling  tube.  The  left  land  is  removed  from  its 
position  at  the  top  of  the  buret  and  the  right  hand  slowly  lowered 
and  again  raised  to  pass  the  sample  back  into  the  sampling  tube. 
This  process  is  repeated  twice  and  the  mercury  reservoir  (6)  then 
hung  on  the  ratchet  at  about  9.0  c.c.  With  the  left  hand  the  mer- 


72  BASAL  METABOLIC   RATE 

cury  reservoir  (13)  on  the  sampling  tube  is  taken  from  its  holder  and 
lowered,  together  with  the  mercury  reservoir  (6)  on  the  buret,  to 
such  a  position  that  the  amount  of  sample  in  the  buret  is  9.5  c.c. 
or  more.  The  mercury  reservoir  (6)  is  hung  up  on  the  ratchet. 
Care  is  taken  to  level  exactly  the  mercury  in  the  sampling  tube  (12) 
and  its  reservoir  so  that  the  air  in  the  buret  will  be  at  atmospheric 
pressure;  the  tap  (11)  of  the  sampling  tube  is  closed  and  the  mer- 
cury reservoir  of  the  sampling  tube  hung  up  on  its  rack.  The  buret 
tap  (8)  is  then  turned  to  close  the  connection  with  the  sampling  tube 
and  put  the  air  in  the  buret  in  connection  with  the  potash  tube  (16). 

(c)  Analysis. — If  the  mercury  levels  of  the  sampling  tube  (12) 
and  its  reservoir  have  been  properly  adjusted,  the  potash  levels  will 
change  very  little  when  the  buret  tap  (8)  is  turned  into  the  potash 
solution  (16).  The  rubber  tubing  of  the  potash  tube  (16)  and  also 
the  tubing  (5)  attached  to  the  buret  should  be  pressed  gently  to  see 
that  the  potash  levels  (15,  25)  respond,  to  make  certain  that  the 
small  openings  in  the  taps  are  not  stopped  up  with  grease.  The 
potash  levels  (15,  25)  are  set  by  carefully  adjusting  the  mercury 
(6)  and  potash  (17)  reservoirs,  and,  with  the  precautions  mentioned 
above,  the  total  volume  of  the  air  sample  is  read  and  recorded. 
A  readjustment  of  the  levels  is  made  as  quickly  as  possible  after 
again  gently  pressing  the  mercury  tube  and  the  rubber  potash  tube 
to  insure  free  communication  and  the  check  reading  of  the  total 
volume  of  air  taken. 

The  air  sample  is  then  passed  back  and  forth  eight  times  in  the 
potash  solution  and  a  reading  of  the  volume  recorded  after  setting 
the  potash  levels  with  great  care.  Again  the  sample  of  air  is  passed 
five  times  into  the  potash  solution  and  the  check  reading  made.  If 
the  readings  do  not  agree  within  0.002  c.c.,  the  procedure  is  re- 
peated until  check  readings  are  obtained.  The  tap  (14)  is  then 
turned  so  that  the  sample  is  passed  into  the  pyro  about  eighteen 
times.  The  potash  tube  by  turning  tap  (14)  properly  is  rinsed 


MANAGEMENT    OF    HALDANE    APPARATUS 


73 


twice  and  the  sample  again  shunted  into  the  pyro  and  passed  back 
and  forth  ten  times.  This  complete  procedure  is  repeated  twice 
again  before  a  reading  is  taken  of  the  volume.  In  making  a  read- 
ing the  pyro  level  is  set  by  means  of  the  mercury  reservoir  (6)  and 
then  the  tap  (14)  is  turned  to  the  potash  tube  and  the  two  potash 
levels  (15,  25)  set.  A  check  reading  is  made  after  rinsing  in  the 
potash  and  again  passing  the  air  back  and  forth  in  the  pyro  ten 
times.  A  duplicate  analysis  is  made,  using,  if  possible,  another 
Haldane  and  following  the  procedure  above.  A  complete  analysis 
and  its  duplicate  follow: 

Case  100,490.     March  5,  1918. 
Haldane  No.  V. 


Reading               Corr. 

Corr. 

Diff. 

Per  cent. 

buret. 

reading. 

9.377 

9.377     +     0.003 

=     9.380 

9.137 

9.136     +     0.007 

=     9.143     = 

0.237 

=       2.53%  C02 

7.443 

7.444     +     0.020 

=     7.464     = 

1.679 

=     17.90%  02 

Reading 
buret. 

9.548 
9.548     + 
9.303 
9.303     + 
7.589 
7.579 
7.579     + 


Corr. 
0.004 

0.006 


Haldane  No.  III. 

Corr.  Diff. 

reading. 


Per  cent. 


9.552 
9.309 


0.243 


2.54%  C02 


0.023     =     7.602     =     1.707     =     17.87%  O2 


(d)  Care  of  the  Haldane. — Several  of  the  steps  in  the  analysis 
and  management  of  the  gas  analysis  apparatus  deserve  further  dis- 


cussion. 


Whenever  check  readings  on  carbon  dioxid  or  oxygen  absorp- 
tion cannot  be  obtained  within  a  reasonable  time,  the  difficulty  is 
usually  due  to  the  following  causes:  A  leaky  tap  from  faulty 
greasing ;  an  insufficiency  of  water  in  the  buret  to  saturate  the  air, 
or  pieces  of  grease  or  mercury  obstructing  the  taps  or  capillary 
tubing,  or  inaccuracy  in  adjusting  the  levels. 


74  BASAL   METABOLIC   RATE 

In  transferring  the  sample  into  the  buret  the  "dead  space"  of 
the  connections  from  the  sampling  tube  to  the  sampling  tap  and 
the  upper  part  of  the  buret  are  thoroughly  rinsed  with  the  sample 
to  be  analyzed.  After  each  rinsing  the  small  portion  of  sample 
used  for  this  purpose  is  allowed  to  escape  into  the  room  in  the  manner 
described  above.  The  escape  of  the  air  must  be  slow  and  gradual 
so  as  to  prevent  any  back-lash  of  the  mercury.  When  the  sample 
is  taken  into  the  buret  it  should  be  transferred  slowly,  so  that  the 
air  may  become  thoroughly  saturated  with  water  vapor  and  also 
prevent  any  mercury  from  sticking  to  the  sides  of  the  buret.  The 
importance  of  having  sufficient  acidulated  water  in  the  buret  must 
be  emphasized.  The  presence  of  acid  prevents  the  water  from 
becoming  alkaline  from  contact  with  the  glass  buret  and,  therefore, 
from  absorbing  carbon  dioxid.  When  the  buret  is  dry  it  is  impossi- 
ble to  get  constant  readings;  the  potash  levels  change,  and  the 
readings,  which  show  a  slight  continual  decrease  in  the  volume 
of  the  air,  apparently  indicate  that  the  machine  is  leaking.  If  at 
this  point  the  sample  is  allowed  to  stand  for  a  few  minutes  in  the 
buret  and  in  connection  with  the  potash  solution  it  will  take  up 
moisture  and  so  increase  in  volume;  in  this  way  it  is  sometimes 
possible  to  obtain  check  readings  and  so  prevent  the  loss  of  the 
analysis.  As  Haldane  states:  "If  the  buret  is  allowed  to  become  dry- 
very  appreciable  errors  are  produced.  A  sample  of  pure  air  will,  for 
instance,  probably  increase  in  volume  when  passed  over  into  the 
potash  pipet,  as  the  air  will  take  up  more  moisture  than  it  loses  of 
carbon  dioxid  in  contact  with  the  potash  solution."  An  excess  of 
water  insures  that  under  all  conditions  the  volume  of  the  gas  meas- 
ured is  completely  saturated  with  water  vapor,  and,  therefore,  the 
contractions  from  absorption  of  carbon  dioxid  and  oxygen  will  be 
proportional  to  those  obtained  had  the  gas  been  absolutely  dry. 
On  the  other  hand,  too  much  water  in  the  buret  decreases  the  volume 
•of  air  and  so  gives  incorrect,  although  constant,  readings. 


MANAGEMENT    OF    HALDANE    APPARATUS  75 

A  dirty  buret  vitiates  the  analyses,  especially  the  oxygen  deter- 
mination, causing  the  latter  to  be  appreciably  higher,  and  if  very 
dirty,  amounting  to  an  error  of  0.10  per  cent.  If  the  buret  is 
cleaned  before  it  becomes  very  dirty  the  process  is  much  easier. 
In  cleaning,  the  buret  is  filled  through  the  top  with  concentrated 
nitric  acid  diluted  with  an  equal  amount  of  distilled  water  and  al- 
lowed to  stand  for  one-half  hour.  The  nitric  acid  is  then  removed 
and  a  long  pipe-stem  cleaner  is  very  carefully  run  down  the  length 
of  the  buret.  After  removing  the  pipe -stem  cleaner  the  buret  is 
washed  thoroughly  and  repeatedly  with  distilled  water  and  finally 
with  distilled  water  containing  a  few  drops  of  sulphuric  acid.  A 
very  dirty  buret,  however,  must  be  cleaned  with  warm  cleaning 
solution,  or  concentrated  nitric  acid,  and  for  this  it  is  necessary  to 
disconnect  the  rubber  tubing  (5)  and  suck  the  acid  up  into  the 
buret.  Alcohol  and  ether  should  never  be  used  for  cleaning  gas 
analysis  apparatus,  because  it  is  very  difficult  to  remove  the  last 
traces  and  their  vapor  may  cause  serious  analytic  errors. 

The  control  tap  (18)  is  closed  to  room  air  during  an  analysis,  but 
on  account  of  changes  in  the  temperature  of  the  room  it  is  often 
necessary  between  analyses  to  open  the  tap  and  reset  the  tw6  pot- 
ash levels  (15,  25)  at  room  air  pressure.  It  is  not  necessary  at  this 
point  to  get  check  readings  of  the  nitrogen.  There  must  be  free 
connection  between  the  potash  manometer  (25)  and  the  control 
tube  (3);  otherwise  there  is  no  longer  a  correct  compensation  for 
temperature  and  pressure  changes  and  the  analyses  will  be  incor- 
rect; grease  in  the  tap  bore  is  usually  the  cause  of  this  error.  Occa- 
sionally during  an  analysis  the  temperature  changes  are  such  that 
the  range  of  adjustment  of  the  potash  reservoir  (17)  is  insufficient 
to  properly  set  the  level  in  the  manometer  tube  (25),  and  to  over- 
come this  difficulty  potash  solution  is  either  added  to  or  removed 
from  the  reservoir  (17)  by  means  of  a  capillary  pipet. 

When  through  using  a  machine  the  control  tap  (18)  should  be 


76  BASAL  METABOLIC   RATE 

opened  to  room  air,  manometer,  and  control  tube;  otherwise  tem- 
perature changes  may  suck  the  potash  up  into  the  taps.  The  pot- 
ash tap  (14)  should  also  be  turned  so  that  the  solutions  are  not  in 
connection  with  the  buret,  to  prevent  them  from  getting  into  the 
taps  or  buret  in  case  of  any  accident  to  the  apparatus. 

The  absorption  of  the  last  traces  of  oxygen  is  slow  and,  if  the 
check  reading  is  taken  too  soon,  the  readings  may  be  practically 
unchanged  from  the  preceding  reading  and  yet  all  the  oxygen 
may  not  be  absorbed;  at  least  two  minutes  of  shaking  by  the  me- 
chanical shaker  should  be  allowed  between  check  readings.  The  use 
of  tubes  in  the  pyro  pipet  materially  increases  the  rapidity  of  the 
oxygen  absorption  because  of  the  increased  surface  area.  With 
their  use  the  pyro,  especially  when  it  has  become  thick  from  use, 
is  liable  to  form  air  bubbles  which  must  be  carefully  watched  for, 
and  the  pyro  changed  as  soon  as  their  tendency  to  develop  is  no- 
ticed. If  the  pyro  is  either  very  new  or  nearly  used  up  it  absorbs 
the  last  traces  of  oxygen  very  slowly. 

Since  the  liquids  are  controlled  by  the  movements  of  the  mercury 
reservoir,  it  sometimes  happens  that  they  are  sucked  over  into  the 
buret.  The  machine  should  be  cleaned  as  soon  as  the  accident 
happens.  In  such  a  case  the  buret  and  connections  must  be  thor- 
oughly washed  first  with  dilute  sulphuric  acid  (1  part  sulphuric  to 
3  parts  distilled  water)  and  finally  with  distilled  water,  slightly 
acidified  with  sulphuric  acid.  The  presence  of  'the  strong  alkaline 
solutions  on  the  taps  may  cause  them  to  be  frozen  into  their  bores, 
and  for  this  reason  they  must  be  carefully  cleaned  of  the  alkaline 
solution. 

Sulphid-free  black  rubber  tubing  must  be  used  on  the  potash 
absorption  pipet.  The  ordinary  black  tubing  contains  various 
sulphur  compounds,  which  are  more  or  less  soluble  in  potash,  giving 
a  yellowish  tinge  to  the  solution.  Such  a  solution  tends  to  absorb 
oxygen  so  that  the  carbon  dioxid  reading  in  consequence  will  be 


MANAGEMENT    OF    HALDANE    APPARATUS  77 

too  high.  It  is  also  better  to  use  this  black  sulphid-free  tubing 
on  the  pyro  pipet.  The  rest  of  the  connections  which  do  not 
come  in  contact  with  the  absorbing  liquids  are  made  with  heavy 
red  pressure  tubing.  The  bore  of  the  pressure  tubing  is  covered 
with  talc  which  should  be  carefully  removed  before  using  to  prevent 
any  leaks.  To  remove  the  talc  the  tubing  is  soaked  in  soap  and 
water  and  the  bore  carefully  scrubbed  with  a  pipe-stem  cleaner; 
it  should  then  be  thoroughly  rinsed  in  distilled  water  slightly  acidi- 
fied with  sulphuric  acid. 

Practically  the  only  source  of  leaks  on  a  Haldane  that  is  care- 
fully set  up  is  due  to  the  improper  greasing  of  the  taps.  In  greas- 
ing, the  tap  and  its  bore  should  be  thoroughly  wiped  off  with  a  soft 
cloth  and  the  tap  covered  with  a  very  thin  layer  of  grease,  avoiding 
an  excess  which  might  clog  the  openings.  When  the  greased  tap  is 
turned  in  its  bore  there  should  be  no  stria tions  and  the  tap  should 
turn  smoothly.  In  cleaning  the  bore  pipe-stem  cleaners  are  very 
satisfactory,  but  care  must  be  taken  not  to  scratch  the  glass 
with  the  uncovered  wire.  In  manipulating  a  tap  the  handle  is 
turned  by  the  thumb  and  index-finger  at  the  same  time  pressing 
gently  inward;  care,  however,  must  be  used  not  to  press  too  hard, 
as  thereby  the  grease  is  squeezed  out,  causing  binding  of  the  tap 
and  so  necessitating  regreasing.  Beginners  have  a  tendency  to  pull 
the  tap  out  in  turning  it  and  so  causing  a  leak. 

(e)  Filling  the  Haldane. — The  solutions  in  the  machine  are 
changed  whenever  the  pyro  gives  an  oxygen  content  of  outdoor 
air  below  20.90  per  cent.,  or  whenever  the  pyro  becomes  thick  and 
tends  to  catch  air  bubbles.  The  potash  solution  is  readily  changed 
by  taking  out  the  taps  (14)  and  (18),  and  by  removing  the  potash 
container  (17)  from  its  holder,  to  allow  the  solution  to  run  out. 
The  pipet  is  rinsed  with  dilute  hydrochloric  acid  to  dissolve  the 
thin  film  of  carbonate  formed,  and  then  repeatedly  washed  with 
distilled  water.  Fresh  potash  solution  of  specific  gravity  1.15  is 


7 8  BASAL   METABOLIC   RATE 

then  put  in  the  pipet  through  the  potash  reservoir.  The  potash 
should  stand  at  the  two  levels  (15)  and  (25)  and  half-way  up  in  the 
stem  of  the  potash  reservoir  when  the  latter  is  placed  in  its  holder. 
In  filling  the  pyro  pipet  the  tap  (19)  is  taken  out  and  then  the  solid 
glass  rod  (30)  is  removed  from  the  lower  end  of  the  rubber  tubing 
attached  to  the  pipet.  By  means  of  a  glass  funnel  and  an  extra 
piece  of  rubber  tubing  and  glass  connection  the  pipet  (21)  is  thor- 
oughly cleaned  with  water  and  finally  filled  to  its  proper  level  with 
the  pyro  solution,  and  the  solid  glass  rod  is  reinserted  in  the  end  of 
the  rubber  tube.  It  is  not  necessary  to  change  the  potash  solution 
in  the  seal,  although  water  must  be  added  from  time  to  time  to 
replace  that  lost  by  evaporation,  and  so  prevent  breaking  of  the 
seal.  The  buret  should  be  thoroughly  cleaned  whenever  the  solu- 
tions are  changed.  The  water-bath  should  be  kept  clean  and  com- 
pletely filled  with  distilled  water.  If  the  bulbs  of  the  buret  or  con- 
trol tube  are  only  partly  covered  with  water,  temperature  changes 
will  affect  the  readings  of  the  air  volume.  About  20  c.c.  of  mercury 
are  introduced  into  the  buret  through  the  reservoir  (6)  attached  to 
the  buret  by  means  of  rubber  tubing  (5).  The  mercury  should  be 
changed  whenever  it  becomes  dirty. 

6.  Analysis  of  Outdoor  Air. — The  limit  of  accuracy  attainable 
by  a  skilled  analyst  using  a  Haldane  gas  analysis  apparatus  with  a 
perfectly  clean  buret  is  ^O.Ol  per  cent.  In  routine  work,  however, 
this  error  increases  to  ±0.03  per  cent,  for  oxygen.  In  all  work  done 
in  our  laboratory  analyses  are  made  in  duplicate  and  must  agree 
in  the  carbon  dioxid  determination  within  ±0.02  per  cent,  and  in 
the  oxygen  determination  within  ±0.03  per  cent  of  the  average. 

Haldane  has  found  with  this  apparatus  that  outdoor  air  con- 
tains 0.03  per  cent,  carbon  dioxid  and  20.93  per  cent,  oxygen,  and 
with  his  large  apparatus  the  carbon  dioxid  was  0.030  per  cent,  and 
the  oxygen  20.928  per  cent.  Benedict7  found  that  the  average 
result  of  212  analyses  of  out-door  air  using  the  Sonden  apparatus 


SHAKER  79 

was  0.031  per  cent,  carbon  dioxid  and  20.938  per  cent,  oxygen,  the 
balance  being  due  to  nitrogen  and  inert  gases.  In  one  series  of  349 
analyses  of  out-door  air  nearly  equally  divided  among  18  Haldane 
gas  analysis  apparatus  which  had  been  calibrated  in  duplicate  by 
mercury,  as  described  on  page  60,  we  found  the  average  carbon 
dioxid  content  to  be  0.037  per  cent,  and  the  oxygen  content  20.930 
per  cent.  In  a  second  series  of  343  analyses  the  average  carbon 
dioxid  was  0.035  per  cent,  and  the  average  oxygen  20.930  per  cent. 
The  average  of  the  two  series  of  692  analyses  was  0.036  per  cent, 
for  carbon  dioxid  and  20.930  per  cent,  for  oxygen.  The  outdoor 
air  for  these  analyses  was  taken  from  the  fire  escape  outside  the 
laboratory  \vindow  and  in  the  center  of  Rochester,  Minnesota.  On 
account  of  the  large  number  of  chimneys  in  the  neighborhood  vary- 
ing amounts  of  smoke  drifted  toward  the  laboratory;  this  probably 
accounts  for  the  differences  in  the  carbon  dioxid  and  oxygen  per- 
centages found  by  us  as  compared  with  the  results  obtained  both 
by  Haldane  and  Benedict.  Therefore  in  our  calculations  and  in 
Table  III  of  the  Appendix  we  have  adopted  as  an  average  for  out- 
door air  0.04  per  cent,  of  carbon  dioxid  and  20.93  per  cent,  of  oxygen. 
Room  air,  however,  has  a  variable  composition  (page  41)  with  an 
increase  in  the  carbon  dioxid  and  a  corresponding  decrease  in  the 
oxygen  content,  the  variations  depending  mainly  on  the  size  of  the 
room,  the  number  of  occupants,  and  the  efficiency  of  the  ventilating 
system.  As  a  routine  procedure  an  outdoor  air  analysis  is  done 
once  a  week  on  every  Haldane  machine  and  a  record  kept  on  file. 
We  consider  it  essential  that  such  control  air  analyses  be  made 
regularly  to  indicate  the  accuracy  of  the  apparatus,  the  efficiency 
of  the  absorbing  solutions,  and  the  skill  of  the  analyst  (Form  IV, 
Appendix). 

7.  Shaker. — When  many  analyses  are  being  done,  using  several 
machines,  some  mechanical  device  should  be  used  to  raise  and 
lower  the  mercury  reservoirs  (6).  For  this  purpose  we  have  beside 


80  BASAL  METABOLIC   RATE 

each  of  our  18  Haldanes  an  arm  (28)  about  12  inches  long  which 
rises  and  falls  at  its  outer  end  from  3^2  to  4  inches  ten  to  twelve 
times  a  minute.  This  arm  is  driven  by  light  shafting  (27)  from  an 
eccentric  geared  down  from  a  one-sixth  horse-power  electric  motor. 
The  exact  throw  for  each  Haldane  is  obtained  by  varying  the  posi- 
tion of  the  hook  (26)  on  the  arm  upon  which  the  mercury  reservoir 
is  hung.  The  level  of  the  arm  (28)  is  adjusted  by  a  thumb-screw 
by  means  of  which  it  is  clamped  to  the  shafting  (27).  The  most 
efficient  throw  is  one  which  keeps  the  mercury  in  the  bulb,  never 
in  the  stem  of  the  buret.  While  a  single  analysis  cannot  be  done 
as  quickly  by  this  method  as  by  hand,  it  allows  one  person  to  run 
from  four  to  six  machines  and  at  the  same  time  to  calculate  the 
analyses.  An  experienced  analyst  can  thus  do  from  twelve  to 
sixteen  complete  analyses  and  their  calculations  in  a  morning. 

D.    SOLUTIONS 

1.  Potassium  Pyrogallate  Solution  (Haldane). — To  600  gm.  of 

stick  potassium  hydroxid  (not  purified  by  alcohol)  are  added  300  c.c. 
of  distilled  water.  The  specific  gravity  of  the  resulting  solution 
should  be  exactly  1.55  (this  can  be  determined  by  using  a  hydrom- 
eter or  by  finding  the  weight  of  100  c.c.  of  the  solution,  which 
should  be  155  gm.).  If  the  specific  gravity  is  too  low,  potassium  hy- 
droxid should  be  added  until  the  desired  concentration  is  obtained. 
To  100  c.c.  of  this  concentrated  potash  solution  10  gm.  of  Merck's 
pyrogallic  acid  are  added  in  a  bottle  with  a  greased  stopper.  Hal- 
dane states  that  the  solution  should  be  made  exactly  in  the  manner 
described.  The  resulting  solution  of  potassium  pyrogallate  should 
have  a  brownish-green  tint  and  should  become  a  deep  wine  color 
immediately  on  exposure  to  air.  The  pyro  should  be  at  least  a 
month  old  before  using,  although  it  improves  with  greater  age. 
This  "aging"  can  sometimes  be  hastened  by  exposing  the  pyro  for 
a  few  minutes  to  air  and  thus  giving  it  a  "start." 


CLEANING   MERCURY  8 1 

2.  Potash  Solution  for  Carbon  Dioxid  Absorption. — For  the  ab- 
sorption of  carbon  dioxid  we  use  a  dilute  solution  of  potassium 
hydroxid  of  specific  gravity  of  about  1.15,  approximately  a  17  per 
cent,  solution. 

3.  Black  Rubber  Grease. — Ordinary  black  rubber  tubing  of 
small  diameter  is  washed  in  water  to  remove  the  talc.    Then  it  is 
cut  into  very  small  pieces  and  slowly  added  to  an  equal  quantity 
of  lanolin  which  has  been  melted  (about  2  tablespoonfuls  of  finely 
cut  tubing  and  of  lanolin).    The  rubber  is  allowed  to  melt,  using 
a  slow  flame  until  the  resulting  liquid  is  free  from  any  lumps. 
The  grease  should  be  very  smooth  and  of  a  consistency  slightly 
firmer  than  lanolin.     While  still  melted  the  grease  is  poured  into 
a  small  "cold  cream'7  jar.     It  is  a  very  satisfactory  grease  for  glass 
taps,  it  wears  well,  and  if  sufficiently  thin  it  will  not  clog  the  tap. 

4.  Cleaning  Solution. — This  should  be  used  to  remove  grease 
from  glass  apparatus  like  the  sampling  tubes  and  occasionally  the 
buret  of  the  Haldane.     It  is  a  supersaturated  solution  of  potassium 
bichromate  in  concentrated  sulphuric  acid.    It  is  more  efficient 
when  warm  and  can  be  used  over  and  over  until  the  solution  has 
become  green,  when  it  should  be  discarded. 

5.  Cleaning  Mercury. — The  mercury  used  in  the  type  of  gas 
analysis  described  becomes  very  dirty  from  grease,  dust,  and  from 
forming  an  amalgam  with  the  copper  wire  used  to  wire  the  connec- 
tions of  the  Haldane  and  sampling  tubes.     In  cleaning,  the  mercury 
should  be  first  wrung  through  several  layers  of  close  meshed  towels. 
It  is  then  covered  with  nitric  acid  (1  part  concentrated  nitric  acid 
to  1  part  distilled  water)  and  air  bubbled  through  it  for  several 
hours.    The  same  procedure  is  repeated,  using  distilled  water,  so 
that  the  mercury  is  no  longer  acid.    The  excess  water  is  removed 
with  filter-paper  and  the  mercury  is  allowed  to  stand  until  all  the 
water  has  evaporated,  leaving  the  mercury  dry. 

6 


SECTION  III 
CALCULATION  OF  BASAL  METABOLIC  RATE 

WHILE  the  patient  is  in  the  laboratory  the  following  data  are 
obtained:  The  gasometer  readings  at  the  start  and  at  the  end  of 
the  test,  and  the  duration  of  the  test  in  minutes  and  seconds;  the 
temperature  of  the  expired  air  at  the  time  of  the  final  volumetric 
readings  and  the  barometric  pressure,  and  finally,  the  patient's 
height,  weight,  pulse,  and  blood-pressure.  A  detailed  calculation 
of  the  basal  metabolic  rate  step  by  step  is  given  below.  On  Form  II, 
Appendix,  is  shown  a  routine  calculation  in  the  same  case  in  which 
our  forms  and  calculation  tables  devised  to  simplify  the  procedure 
are  used. 

1.  Volume  of  Expired  Air. 

5-14-18.     Case  A  172,918;  F.   50;  wt.  53.7  kg.;  ht.  159.4cm. 
Barometer  738.8  mm.     Temperature  gasometer  21.6°  C. 

I.  II. 

Gasometer  reading  at  end 63.90  cm.     65.90  cm. 

Gasometer  reading  at  start 1.50  cm.       3.50  cm. 


Gasometer  difference 62.40cm.     62.40cm. 

Since  by  calibration  we  have  found  that  a  rise  of  1  cm.  on  the 
steel  tape  corresponds  to  1.256  1.  (the  factor  of  the  gasometer), 
the  volume  of  the  expired  air  is 

62.4  cm.  X  1.256  =  78.38  1.  at  738.8  mm.  and  21.6°  C. 

In  order  to  compare  the  volumes  of  gases  with  each  other,  a 
standard  pressure  and  temperature  have  been  universally  adopted, 
and  the  volumes  of  all  gases  are  expressed  under  the  standard  con- 
ditions at  a  pressure  of  760  mm.  of  mercury  and  at  a  temperature  of 
0°  C.  (or  at  absolute  temperature  273°+  0°  C.)  and  dry.32  The 

gas  volume,  78.38  1.,  has,  therefore,  to  be  reduced   to   standard 

82 


REDUCTION   TO    STANDARD    TEMPERATURE  83 

conditions  of  temperature  and  pressure.  To  do  this  the  following 
steps  are  necessary,  and  the  various  factors  are  obtained  from  Lan- 
dolt,  Bornstein,  and  Roth: 

2.  Correction  of  Barometer  to  0°  C. — The  barometer  reading 
must  first  be  corrected  for  the  temperature  of  the  mercury,  since 
the  density  of  the  mercury  varies  with  variations  in  temperature. 
The  temperature  of  the  barometer  is  21.6°  C.,  and  at  this  tempera- 
ture the  correction  for  the  density  of  mercury  for  a  barometer  read- 
ing recorded  on  a  brass  scale  is  2.6  mm.     The  corrected  barometer 
reading  is  738.8  mm.  —  2.6  mm.  =  736.2  mm. 

3.  Correction  for  Water  Vapor. — The  expired  air  is  saturated 
with  water  vapor;  therefore  the  volume  of  the  air,  if  dry,  would  be 
smaller.     The  pressure  of  water  vapor  for  the  temperature  at  which 
the  volume  is  read  must  be  deducted  from  the  barometer  reading. 
At  the  temperature  of  21.6°  C.  this  correction  is  19.4  mm.     Con- 
sequently the  pressure  of  the  dry  expired  air  is  736.2  mm.  —  19.4 
mm.  =  716.8  mm. 

4.  Reduction   to    Standard   Pressure. — According    to    Boyle's 
law  the  volume  of  a  gas  is  inversely  proportional  to  the  pressure, 
provided  the  temperature  remains  constant.     To  correct  to  the 
standard  pressure  of  760  mm.  the  following  procedure  is  necessary: 

78.38  :    x     =     760  :  716.8 
716.8 

or  78.38     X     =     73.93  1.  at  760  mm.  and  21.6°  C.,  dry. 

760 

5.  Reduction  to  Standard  Temperature. — Charles'  law  states 
that,  provided  the  pressure  remains  constant,  the  volume  of  a  gas 
will  change  ^73-  of  its  volume  at  0°  for  each  degree  of  change  of 
temperature.    To  reduce  the  above  gas  volume  to  standard  tem- 
perature the  following  calculation  must  be  done : 

73.93  :    x     =     273     +     21.6  :  273     +     0 
273     +     0 

or  73.93     X     =     68.52  1.  at  760  mm.  and  0°  C.,  dry. 

273     +     21.6 


84  BASAL  METABOLIC  RATE 

6.  Ventilation  Rate. — This  volume  at  standard  pressure  and 
temperature  dry  has  been  expired  by  the  patient  in  11  minutes 
and  4  seconds  (or  11.07  minutes).  The  volume  per  minute  or,  as 
it  is  called,  the  ventilation  rate  per  minute  is,  therefore, 

68.52  1. 

=     6.191.  per  minute. 


11.07min. 

7.  Carbon  Dioxid  Production. — Duplicate  analyses  show  that 
the  expired  air  from  the  above  test  contained 

3.00  per  cent.  CO2 
17.53  per  cent.  O2 
79.47  per  cent.  N2 

Outdoor  air  has  the  following  composition  (page  78) : 

0.04  per  cent.  CO2 
20.93  per  cent.  O2 
79.03  per  cent.  N2  (including  all  the  inert  gases). 

The  carbon  dioxid  produced  by  the  patient  per  minute  is,  there- 
fore, 

3.00     -     0.04 

X     6.191.     =     0.1831.  or  183  c.c. 

100 

8.  Oxygen  Absorption. — The  volume  of  oxygen  absorbed  is  more 
difficult  to  calculate  than  the  carbon  dioxid  elimination,  since  the 
inspired  air  during  the  process  of  respiration  has  decreased  in 
volume  due  to  the  fact  that  more  oxygen  has  been  absorbed  from  it 
than  carbon  dioxid  has  been  given  off.  From  a  comparison  of  the 
analyses  of  the  expired  with  the  inspired  air  it  will  be  seen  that  the 
nitrogen  readings  have  changed,  the  nitrogen  of  the  expired  air 
being  larger,  although  nitrogen  is  in  no  way  involved  in  physiologic 
processes,  and  should,  therefore,  remain  unchanged.  Since  nitrogen 
is  neither  taken  up  nor  given  off  in  respiration,  it  is  evident  that  for 


RESPIRATORY   QUOTIENT  85 

every  100  volumes  of  expired  air  there  corresponded  in  the  inspired 
air  not  20.93  volumes  of  oxygen,  but 


79.47 

20.93     X     =     21.05  volumes. 

79.03 


Hence  the  oxygen  absorption  is 
21.05     -     17.53 


100 


X     6.191.     =     0.2181.  or  218  c.c. 


If  instead  of  outdoor  air  the  patient  inspires  room  air  it  is 
obvious  that  the  figures  found  on  analysis  of  the  latter  must  be 
substituted  in  those  places  where  the  composition  of  the  inspired 
air  enters  into  the  calculation.  The  values  for  the  correction  of  the 
inspired  oxygen  percentage  given  in  Table  III  can  be  utilized  by 
subtracting  from  them  the  difference  between  the  percentage  of 
oxygen  in  outdoor  air  (20.93)  and  the  percentage  of  oxygen  in  the 
inspired  room  air. 

9.  Respiratory  Quotient. — The  respiratory  quotient  is  the 
ratio  between  the  volume  of  the  carbon  dioxid  produced  and  the 
corresponding  volume  of  oxygen  absorbed, 

183  c.c.  CO2 

or  —  —     =     0.84,  the  respiratory  quotient. 

218  c.c.  O2 

The  respiratory  quotient  when  not  affected  by  abnormal  respi- 
ration indicates  the  kind  of  material  being  burned  in  the  body.  Thus 
when  pure  carbohydrate  is  burned  the  reaction  is 

C6H12O6     +     6O2     =     6CO2     +     6H2O 

And  the  ratio  of  the  volume  of  carbon  dioxid  produced  to  the  volume 

of  oxygen  absorbed  is 

6CO2 

=    1.00 

602 


86  BASAL   METABOLIC   RATE 

For  protein  the  respiratory  quotient  is  0.80  and  for  fat  0.71,  and 
for  a  mixed  diet  consisting  of  all  three  substances  the  quotient  will 
average  about  0.84.  It  is  necessary  to  know  the  value  of  the 
respiratory  quotient  since  the  calorific  value  of  1  liter  of  oxygen  is 
5.047  when  the  respiratory  quotient  is  1.00,  but  is  only  4.690 
when  the  respiratory  quotient  is  0.71.  Consequently,  the  number 
of  calories  produced  when  1  liter  of  oxygen  is  absorbed  will  depend 
on  the  food  substances  being  burned. 

10.  Calories  per  Square  Meter  per  Hour. — For  a  quotient  of 
0.84  the  calorific  value  of  1  liter  of  oxygen  is  4.850  (using  the  value 
for  the  non-protein  respiratory  quotient,  a  negligible  error  which 
will  be  explained  later) .  Therefore,  the  number  of  calories  produced 
per  hour  will  be 

0.218  1.     X     60     min.     X     4.850  cal.     =     63.4  cal.  per  hour. 

Du  Bois  has  shown  that  the  heat  production  is  proportional  to  the 
surface  area.  From  Du  Bois'  height- weight  chart  the  surface  area 
corresponding  to  a  height  of  159.4  cm.  and  a  weight  of  53.7  kg.  is 
1.54  sq.  m.  The  number  of  calories  produced  per  square  meter  of 
body  surface  per  hour  is 

63.4  cal. 


1.54  sq.  m. 


41.2  cal.  per  sq.  m.  per  hour. 


11.  Basal  Metabolic  Rate  (B.  M.  R.).— The  normal  standard 
for  a  woman  aged  fifty  is  35.0  cal.;  therefore,  this  patient  has  a 
basal  metabolic  rate  of 

41.2     -     35.0 

—     =      +18  per  cent. 
35.0 

12.  Checking  Calculations.— In  order  to  avoid  technical  errors 
all  original  observations  are  made  by  two  independent  sets  of  read- 
ings, as  will  be  noted  throughout  the  description  of  the  technic, 
and  checked  by  a  second  observer.     The  calculations  are  carried 


NON-PROTEIN   RESPIRATORY    QUOTIENT  87 

out  as  on  Forms  I  and  II  of  the  Appendix,  and  completely  checked 
by  a  second  calculator  before  the  results  are  reported.  The  follow- 
ing morning  all  the  calculations  of  the  previous  day  are  rechecked 
by  a  third  calculator. 

13.  Non-protein  Respiratory  Quotient. — The  calorific  value  of 
1  liter  of  oxygen  when  protein  is  burned  is  4.485 ;  when  fat  is  burned, 
4.686;  when  carbohydrate  is  burned,  5.047.  To  apportion  the  quan- 
tity of  heat  derived  from  the  combustion  of  protein,  fat,  and  car- 
bohydrate the  following  additional  steps  are  necessary:  The 
amount  of  heat  produced  from  protein  can  be  calculated  if  the  total 
nitrogen  in  the  urine  is  known,  because  every  gram  of  nitrogen 
appearing  in  the  urine  indicates  a  heat  production  of  26.51  cal.,  dur- 
ing which  process  5.91 1.  of  oxygen  are  consumed  and  4.76 1.  of  carbon 
dioxid  given  off.  To  obtain  the  amount  of  heat  by  the  method  of 
indirect  calorimetry  resulting  from  the  combustion  of  fat  and  car- 
bohydrate the  amount  of  carbon  dioxid  and  oxygen  due  to  protein 
combusion  must  be  subtracted  from  the  respiratory  carbon  dioxid 
and  oxygen,  and  the  oxygen  difference  then  multiplied  by  the  calo- 
rific value  of  oxygen  for  the  resultant  respiratory  quotient  from 
the  combustion  of  fat  and  carbohydrate  (non-protein  respiratory 
quotient).  The  total  metabolism  will  be  the  sum  of  the  heat  pro- 
duced by  the  combustion  of  protein  added  to  that  from  the  com- 
bustion of  carbohydrate  and  fat. 

Magnus-Levy  has  shown  that  the  calculation  of  the  protein  and 
non-protein  heat  separately  rarely  makes  a  difference  of  3  per  cent, 
in  the  amount  of  heat  found  by  neglecting  this  refinement  and  cal- 
culating directly  the  heat  from  the  average  respiratory  quotient 
and  total  carbon  dioxid  elimination  and  oxygen  consumption. 
Furthermore,  the  inability  to  obtain  exact  urinary  nitrogen  deter- 
minations for  short  periods  such  as  used  in  indirect  calorimetry 
renders  the  refinement  of  questionable  value.  Therefore  in  all 
our  calculations  we  neglect  this  step. 


88  BASAL  METABOLIC  RATE 

A  complete  calculation  from  the  protein  and  non-protein  factors 
to  obtain  the  non-protein  respiratory  quotient  and  to  apportion55 
the  heat  due  to  the  combustion  of  protein,  fat,  and  carbohydrate  in 
the  case  given  above  is  a's  follows : 

CO2  =  183  c.c.  per  min.  or  10.98  1.  per  hour. 

Oz  =  218  c.c.  per  min.  or  13.08  1.  per  hour. 

Urinary  nitrogen  per  hour  =  0.333  gm. 

Non-protein  CO2  per  hour  =  10.98  1.  —  (0.333  X  4.76)  =  9.39  1. 

Non-protein  O2  per  hour  =  13.08  1.  —  (0.333  X  5.91)  =  11.11  1. 

9.39 
Non-protein  respiratory  quotient  =  =  0.85. 

Calories  derived  from  protein  combustion          =  0.333  X  26.51  =    8.83 
Calories  derived  from  non-protein  combustion  =  11.11  X  4.863  =  54.03 


Total  calories  per  hour  =  62.86 

62.86 
Calories  per  square  meter  per  hour  =  =  40.8. 

1  .U~r 

40.8  —  35.0 
Basal  metabolic  rate  =  -  -  --   =  +17  per  cent. 


Combustion  due  to  carbohydrate  =  54.03  X  49  per  cent.  =  26.48  cal. 
Combustion  due  to  fat  =  54.03  X  51  per  cent.  =  27.55  cal. 
Combustion  due  to  protein  =  8.83  cal. 

14.  Calculation  of  Metabolic  Rate  of  a  Diabetic.—  The  calcula- 
tion of  the  metabolic  rate  of  a  diabetic  is  much  more  difficult.  The 
diabetic  organism  is  more  or  less  unable  to  burn  sugar,  depending 
on  the  severity  of  the  disease.  The  relation  between  the  urinary 
nitrogen  and  sugar  elimination  in  the  fasting  and  meat-fed  diabetic? 
the  dextrose  (D)  to  nitrogen  (N)  ratio,  is  the  key  to  the  quantity 
of  sugar  which  can  be  derived  from  protein  metabolism.  Allen 
and  Du  Bois  have  given  the  calculation  of  the  metabolism  of  a  dia- 
betic when  there  is  sugar  formation  from  protein  —  the  details  of 
which  are  given  below: 

"In  the  normal  metabolism  each  gram  of  nitrogen  in  the  urine 
indicates  the  combustion  of  6.25  gm.  protein,  with  the  liberation 
from  this  protein  of  26.51  cal.,  9.35  gm.  carbon  dioxid,  and  the  ab- 
sorption of  8.45  gm.  oxygen.  It  is  obvious  that  if  part  of  this  pro- 


BIBLIOGRAPHY  89 

tein  molecule  is  unoxidized  in  the  diabetic  organism  and  is  excreted 
in  the  urine,  all  of  these  figures  will  be  lowered  by  exactly  the  num- 
ber of  calories  and  grams  of  carbon  dioxid  and  oxygen  lost  in  the 
glucose.  With  the  dextrose-nitrogen  ratio  of  3.65  to  1,  1  gm.  of 
nitrogen  in  the  urine  indicates  the  combustion  of  6.25  gm.  protein 
with  the  liberation  of  26.51  minus  13.47  cal.,  9.35  minus  5.35  gm. 
carbon  dioxid,  and  the  absorption  of  8.45  minus  3.89  gm.  oxygen. 
When  the  dextrose-nitrogen  ratio  is  lower,  the  calculation  is  easily 
made,  as  follows:  The  calories,  carbon  dioxid,  and  oxygen  ascribed 
to  the  metabolism  of  protein  are  calculated  from  the  number  of 
grams  of  nitrogen  excreted  per  hour  by  using  the  normal  factors 
given  by  Lusk.76  Knowing  the  number  of  grams  of  glucose  excreted 
per  hour,  one  can  make  the  proper  subtractions,  since  each  gram  of 
glucose  represents  a  loss  of  3.692  cal.,  1.467  gm.  carbon  dioxid,  and 
1.067  gm.  of  oxygen.  In  this  way  it  is  possible  to  determine  the 
non-protein  respiratory  quotient  and  the  heat  production  by  the 
method  of  indirect  calorimetry.  If  there  is  no  glycosuria,  or  if 
the  sugar  in  the  urine  is  all  derived  from  ingested  carbohydrate, 
the  calculations  are  exactly  the  same  as  for  normal  persons." 

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71.  Soderstrom,  G.  F.,  Barr,  D.  P.,  and  Du  Bois,  E.  F.:    Clinical  Calorimetry, 

Paper  XXVI.  The  Effect  of  a  Small  Breakfast  on  Heat  Production,  Arch. 
Int.  Med.,  xxi,  613-620,  1918. 

72.  Soderstrom,  G.  F.,  Meyer,  A.  L.,  and  Du  Bois,  E.  F.:  Clinical  Calorimetry. 

Paper  XI.  A  Comparison  of  the  Metabolism  of  Men  Flat  in  Bed  and 
Sitting  in  a  Steamer  Chair,  Arch.  Int.  Med.,  xvii,  872,  1916. 

73.  Tissot,  J.:    Nouvelle  methode  de  mesure  et  d'inscription  du  debit  et  des 

mouvements  respiratiores  de  rhomme  et  des  animaux,  Jour,  de  phys.  et 
de  path,  gen.,  vi,  688. 

74.  Von  Noorden,  C.:  Metabolism  and  Practical  Medicine,  3  vols.,  W.  T.  Keener 

&  Co.,  Chicago,  1907.  Excellent  bibliography;  sections  by  Magnus- 
Levy,  A.;  Von  Noorden,  C.;  Kraus,  Fr.;  Schmidt,  A.;  Weintraud,  W.; 
Matthes,  M.;  Strauss,  H.;  Salomon,  H.;  Czerny,  A.;  Steinitz,  H.;  Dapper, 
C.;  Neuberg,  C.;  Loewi,  O.;  Mohr,  L. 

75.  Williams,   H.  B.:    Animal   Calorimetry.      Paper   I.     A  Small    Respiration 

Calorimeter,  Jour.  Biol.  Chem.,  xii,  317,  1912. 

76.  Williams,  H.  B.,  Riche,  J.  A.,  and  Lusk,  G.:   Animal  Calorimetry.     Paper 

II.  Metabolism  of  the  Dog  Following  the  Ingestion  of  Meat  in  Large 
Quantity,  Jour.  Biol.  Chem.,  xii,  349-376,  1912. 

77.  Williamson  and  Russell:  Jour.  Chem.  Soc.,  238,  1868. 

78.  Zuntz,  N.,  and  Schumburg,:     Studien  zu  einer  Physiologic  des  Marsches, 

Berlin,  1901. 


APPENDIX 

EXPLANATION   OF  TABLES 

A  CALCULATION  of  the  basal  metabolic  rate  is  appended  (Forms 
I,  II).  The  form  adopted  by  us  involves  the  use  of  tables  which 
we  have  compiled  to  simplify  the  calculations  detailed  above. 

Table  /. — The  duration  of  the  test  is  recorded  in  minutes  and 
to  the  nearest  second,  and  used  in  the  calculations  as  minutes  and 
decimal  parts  of  a  minute.  Table  I  is  used  to  convert  seconds  into 

decimal  parts  of  a  minute. 

Table  I* 

Equivalent  of  Seconds  in  Decimal 
Parts  of  a  Minute. 


Sec 

.   Min. 

Sec. 

Min. 

Sec 

.   Min. 

1 

0.02 

21  «•«•• 

.35 

41 

—  .68 

2 

.03 

22  

.37 

42 

.70 

5 

.05 

23  

.38 

43 

.72 

4 

•  .07 

24  

.40 

44 

.73 

5 

.08 

25  

.42 

45 

.75 

6 

.10 

26  

.43 

46 

.77 

7 

.12 

27  

.45 

47 

.78 

8 

.13 

28  

.47 

48 

.80 

9 

.15 

29  «•«•— 

.48 

49 

.82 

10 

.17 

30  

.50 

50 

—  -  .83 

11 

.18 

31  

.52 

51 

.85 

12 

.20 

32  

.53 

52 

.87 

13 

.22 

33  

.55 

53 

.88 

14 

.23 

34  

.57 

54 

,90 

15 

.25 

35  

.58 

55 

.92 

16 

.27 

36  

.60 

56 

.93 

17 

.28 

37  

.62 

57 

.95 

18 

.30 

38  

.63 

58 

.97 

19 

.32 

39  

.65 

59 

.98 

20 

.33 

40  — 

.67 

60 

—1.00 

Table  II. — In  this  table  are  given  the  log  factors  for  converting 
in  one  step  the  gas  volumes  to  standard  temperature  and  pressure, 
dry,  including  the  correction  of  the  observed  barometer  readings 
for  the  variations  in  the  density  of  mercury  from  changes  in  tem- 
perature. The  table  gives  the  factors  for  a  barometric  range  from 
700  to  780  mm.  and  for  temperatures  between  15.0°  and  32.0°  C. 

94 


APPENDIX  95 

As  an  example  the  derivation  of  the  factor  used  in  the  experiment 
given  in  the  preceding  pages  is  as  follows : 

Barometer     =     738.8  mm.     =      739  mm. 

Temperature  of  the  barometer  =  temperature  of  the  gasom- 
eter =  21.6°  (21.5°).  We  assume  the  temperature  of  the  barom- 
eter to  be  the  same  as  the  temperature  of  the  gasometer;  as  they 
are  in  adjoining  rooms,  the  error  thus  introduced  is  negligible  and 
the  calculation  greatly  simplified  (a  variation  of  2  degrees  causes  a 
change  of  only  0.1  mm.  in  the  correction).  The  barometer  read- 
ing is  corrected  for  the  density  of  mercury  at  21.5°  C.  thus: 

739.0  mm. 
2.6  mm.  correction  for  density  of  mercury 


736.4  mm.  corrected  barometer. 

The  vapor  tension  of  water  at  21.5°  C.  is  19.2  mm.  and  must 
be  subtracted  from  the  corrected  barometer  reading  to  get  the 
pressure  of  the  air  dry. 

736.4  mm. 
19.2  mm. 

717.2  mm.     =     717  mm. 

In  reducing  the  gas  volume  from  21.5°  to  0°  C.  it  is  necessary 
to  multiply  the  gas  volume  by  the  ratio  273  ~'~-  21 5'  ^ne  ^°S" 
arithm  of  this  ratio  is  0.96702-1  as  given  by  Landolt,  Bornstein, 
and  Roth.  In  the  same  way  the  volume  is  reduced  to  standard 
barometric  pressure  by  multiplying  it  by  the  ratio  ^,  the  log  of 
which  ratio  is  0.97471-1.  We  have  combined  these  log  factors 
for  the  correction  of  the  temperature  and  pressure  into  one,  thus: 

0.96702-1 
0.97471-1 


1.94173-2  or  0.94173-1 


The  log  factor  for  the  experimental  data  of  738.8  mm.  (739)  and 
21.6°  (21.5°)  combining  (1)  the  correction  for  the  density  of  mercury, 


96  BASAL  METABOLIC   RATE 

Table  II. 

Log  Factor  for  Reducing  Volume  of  Gases  to  Standard  Temperature 
and  Pressure, Dry;  Including  Reduction  of  Barometric  freight  to 
Standard  Temperature  (brass  scale). 

Barometer  in  Millimeters. 
Temp. 
°C       700     701    702    703    704     705     706    707    708    709     710 


15.0 

1.9319 

9325 

9331 

9338 

9344 

9351 

9357 

9363 

9369 

9375 

9382 

15.5 

9308 

9314 

9320 

9327 

9333 

9340 

9346 

9352 

9359 

9365 

9372 

16.0 

9298 

9304 

9310 

9317 

9323 

9329 

9335 

9341 

9348 

9354 

9361 

16.5 

9287 

9293 

9299 

9306 

9312 

9318 

9324 

9330 

9337 

9343 

9350 

17.0 

9277 

9283 

9289 

9296 

9302 

9308 

9314 

9320 

9327 

9333 

9340 

17.5 

9266 

9272 

9278 

9284 

9290 

9297 

9303 

9309 

9316 

9322 

9329 

18.0 

9255 

9261 

9267 

9273 

9279 

9286 

9292 

9298 

9305 

9311 

9318 

18.5 

9244 

9250 

9256 

9262 

9268 

9275 

9281 

9287 

9294 

9300 

9307 

19.0 

9233 

9239 

9245 

9251 

9257 

9264 

927.0 

9276 

92.83 

9289 

9296 

19.5 

9222 

9228 

9234 

9240 

9246 

9253 

9259 

9265 

9271 

9278 

9285 

20.0 

9211 

9217 

9223 

9230 

9236 

9242 

9248 

9254 

9260 

9266 

9273 

20.5 

9200 

9206 

9212 

9218 

9224 

9230 

9236 

9242 

9248 

9255 

9262 

21.0 

9188 

9,194 

9200 

9206 

9212 

9219 

9225 

9231 

9237 

9243 

9251 

21.5 

9176 

9182 

9188 

9194 

9200 

9207 

9213 

9219 

9225 

9232 

9239 

22.0 

9164 

9171 

9177 

9183 

9189 

9196 

9202 

9208 

9214 

9221 

9228 

22.5 

9152 

9159 

9166 

9172 

9  ITS 

9185 

9191 

9197 

9203 

9210 

9217 

23.0 

9141 

9147 

9153 

9159 

9166 

9173 

9179 

9186 

9192 

9198 

9205 

23.5 

9129 

9135 

9141 

9147 

9154 

9161 

9167 

9173 

9179 

9186 

9193 

24.0 

9117 

9123 

9129 

9135 

9142 

9149 

9155 

9161 

9167 

9174 

9181 

24.5 

9105 

9111 

9117 

9123 

9130 

9137 

9143 

9149 

9155 

9162 

9169 

25.0 

9093 

9099 

9105 

9111 

9118 

9125 

9131 

9137 

9143 

9150 

9157 

25.5 

9080 

9086 

9092 

9098 

9105 

9112 

9118 

9124 

9130 

9137 

9144 

26.0 

9068 

9074 

9080 

9086 

9093 

9100 

9106 

9112 

9118 

9125 

9132 

26.5 

9056 

9062 

9068 

9074 

9081 

9088 

9094 

9100 

9106 

9113 

9120 

27.0 

9044 

9050 

9056 

9062 

9069 

9076 

9082 

9088 

9094 

9101 

9108 

27.5 

9030 

9037 

9043 

9050 

9056 

9062 

9068 

9074 

9080 

9087 

9094 

28.0 

9017 

9023 

9029 

9035 

9042 

9049 

9055 

9061 

9067 

9074 

9081 

28.5 

9004 

9010 

9016 

9022 

9029 

9036 

9042 

9048 

9054 

9061 

9068 

29.0 

8991 

8997 

9003 

9009 

9016 

9023 

9029 

9035 

9041 

9048 

9055 

29.5 

8977 

8983 

8989 

8995 

9002 

9009 

9015 

9021 

9027 

9034 

9041 

30.0 

8964 

8970 

8976 

8982 

8989 

8996 

9002 

9008 

9014 

9020 

9027 

30.5 

8950 

8956 

8962 

8968 

8975 

8982 

8988 

8994 

9000 

9007 

9014 

31.0 

8937 

8943 

8949 

8955 

8962 

8969 

8975 

8981 

8987 

8994 

9001 

31.5 

8923 

8929 

8935 

8941 

8948 

8955 

8961 

8967 

8973 

8980 

8987 

32.0 

8910 

8916 

8922 

8928 

8935 

8942 

8948 

8954 

8960 

8967 

8974 

(2)  for  aqueous  vapor,  (3)  for  barometric  pressure,  and  (4)  for  tem- 
perature is  0.9417-1. 

As  shown  above,  the  patient  expired  78.38  liters  at  the  experi- 
mental temperature  and  pressure.    To  reduce  the  volume  to  0°  and 


APPENDIX 


97 


Table  II  (Con't.) 

Log  Factor  for  Reducing  Volume  of  Gases  to  Standard  Temperature 
and  Pressure, Dry;  Including  Reduction  of  Barometric  Height  to 
Standard  Temperature  (brass  scale). 


Barometer  in  Millimeters. 


710 


711 


712 


713         714 


715 


716        717         718 


719 


7^0 


15.0 

1.9382 

9388 

9394 

9400 

9406 

9413 

9419 

9425 

9431 

9437 

9444 

15.5 

9372 

9377 

9384 

9389 

9396 

9403 

9409 

9415 

9421 

9426 

9433 

16.0 

9361 

9367 

9373 

9379 

9385 

9392 

9398 

9404 

9410 

9416 

9423 

16.5 

9350 

9356 

9362 

9368 

9374 

9381 

9387 

9393 

9399 

9405 

9412 

17.0 

9340 

9346 

9352 

9358 

9364 

9371 

9377 

9383 

9389 

9395 

9402 

17.5 

9329 

9335 

9341 

9347 

9353 

9360 

9366 

9372 

9378 

9384 

9391 

18.0 

9318 

9324 

9330 

9336 

9342 

9349 

9355 

9361' 

9367 

9373 

9380 

18.5 

9307 

9313 

9319 

9325 

9331 

9338 

9344 

9350 

9356 

9362 

9369 

19.0 

9296 

9302 

9308 

9314 

9320 

9327 

9333 

9339 

9345 

9351 

9358 

19.5 

9285 

9291 

9297 

9303 

9309 

9316 

9322 

9328 

9334 

9340 

9347 

20.0 

9273 

9279 

9285 

9291 

9298 

9305 

9311 

9317 

9323 

9329 

9336 

20.5 

9262 

9268 

9274 

9280 

9287 

9294 

9300 

9306 

9312 

9318 

9325 

21.0 

9251 

9257 

9263 

9269 

9275 

9282 

9288 

9294 

9300 

9306 

9313 

21.5 

9239 

9245 

9251 

9257 

9263 

9270 

9276 

9282 

9288 

9294 

9301 

22.0 

9228 

9234 

9240 

9246 

9252 

9259 

9265 

9271 

9277 

9283 

9290 

22.5 

9217 

9223 

9229 

9235 

9241 

9248 

9254 

9260 

9266 

9272 

9279 

23.0 

9205 

9211 

9217 

9223 

9229 

9236 

9242 

9248 

9254 

.9260 

9267 

23.5 

9193 

9199 

9205 

9211 

9217 

9224 

9230 

9236 

9242 

9248 

9256 

24.0 

9181 

9187 

9193 

9199 

9206 

9212 

9218 

9224 

9230 

9237 

9244 

24.5 

9169 

9175 

9181 

9187 

9194 

9200 

9206 

9212 

9218 

9225 

9232 

25.0 

9157 

9163 

9169 

9175 

9181 

9188 

9194 

9200 

9206 

9213 

9220 

25.5 

9144 

9150 

9156 

9162 

9169 

9176 

9182 

9188 

9194 

9200 

9207 

26.0 

9132 

9138 

9144 

9150 

9157 

9164 

9170 

9176 

9182 

9188 

9195 

26.5 

9120 

9126 

9132 

9138 

9145 

9152 

9158 

9164 

9170 

9176 

9183 

27.0 

9108 

9114 

9120 

9126 

9133 

9140 

9146 

9152 

9158 

9164 

9171 

27.5 

9094 

9100 

9106 

9112 

9119 

9126 

9132 

9138 

9144 

9151 

9158 

28.0 

9081 

9087 

9093 

9099 

9106 

9113 

9119 

9125 

9131 

9138 

9145 

28.5 

9068 

9074 

9080 

9086 

9093 

9100 

9106 

9112 

9118 

9125 

9132 

29.0 

9055 

9061 

9067 

9073 

9080 

9087 

9093 

9099 

9105 

9112 

9119 

29.5 

9041 

9047 

9054 

9061 

9067 

9074 

9080 

9086 

9093 

9099 

9106 

30.0 

9027 

9033 

9040 

9047 

9054 

9061 

9067 

9073 

9080 

9087 

9093 

30.5 

9014 

9020 

9026 

9033 

9040 

9047 

9053 

9059 

9065 

9072 

9079 

31.0 

9001 

9008 

9015 

9021 

9027 

9034 

9040 

9046 

9052 

9059 

9066 

31.5 

8987 

8994 

9000 

9006 

9013 

9020 

9026 

9032 

9038 

9045 

9052 

32.0 

8974 

8980 

8987 

8994 

9000 

9007 

9013 

9019 

9025 

9032 

9059 

760  the  log  factor  0.9417-1  is  added  to  the  log  of  78.38  (0.8944+1), 
giving  the  log  0.8361  +  1,  the  antilog  of  which  is  68.57  liters. 
Throughout  our  calculations  we  use  four  place  logs  without  the 
characteristics. 

7 


98 


BASAL  METABOLIC   RATE 


Table  II  (Con't.) 

Log  Factor  for  Reducing  Volume  of  Gases  to  Standard  Temperature 
and  Pressure, Dry;  Including  Reduction  of  Barometric  Height  to 
Standard  Temperature  (brass  scale)* 

Barometer  in  Millimeters. 


720 


721 


722 


723 


724 


725 


726    727    728    729 


730 


15.0 

1.9444 

9450 

9456 

9462 

9468 

9474 

9480 

9486 

9492 

9498 

9505 

15.5 

9433 

9439 

9445 

9452 

9457 

9464 

9470 

9476 

9482 

9488 

9494 

16.0 

9423 

9429 

9435 

9441 

9447 

9454 

9460 

9466 

9472 

9478 

9484 

16.5 

9412 

9418 

9424 

9430 

9436 

9443 

9449 

9455 

9461 

9467 

9473 

17.0 

9402 

9408 

9414 

9420 

9426 

9433 

9439 

9445 

9451 

9457 

9463 

17,5 

9391 

9397 

9403 

9409 

9415 

9421 

9427 

9433 

9439 

9445 

9452 

18.0 

9380 

9386 

9392 

9398 

9404 

9410 

9416 

9422 

9428 

9434 

9441 

18.5 

9369 

9375 

9381 

9387 

9393 

9399 

9405 

9411 

9417 

9423 

9430 

19.0 

9358 

9364 

9370 

9376 

9382 

9388 

9594 

9400 

9406 

9412 

9419 

19.5 

9347 

9353 

9359 

9365 

9371 

9378 

9384 

9390 

9396 

9402 

9409 

20.0 

9336 

9342 

9348 

9354 

9360 

9367 

9373 

9379 

9385 

9391 

9398 

20.5 

9325 

9331 

9337 

9343 

9349 

9356 

9362 

9368 

9374 

9380 

9387 

21.0 

9313 

9319 

9325 

9331 

9337 

9344 

9350 

9356 

9362 

9368 

9375 

21.5 

9301 

9307 

9313 

9319 

9325 

9332 

9338 

9344 

9350 

9356 

936$ 

22.0 

9290 

9296 

9302 

9308 

9314 

9321 

9327 

9333 

9339 

9345 

9352 

22.5 

9279 

9285 

9291 

9297 

9303 

9310 

9316 

9322 

9328 

9334 

9341 

23.0 

9267 

9273 

9279 

9285 

9291 

9298 

9304 

9310 

9316 

9322 

9329 

23.5 

9256 

9262 

9268 

9274 

9280 

9286 

9292 

9298 

9304 

9310 

9317 

24.0 

9244 

9250 

9256 

9262 

9268 

9274 

9280 

9286 

9292 

9298 

9305 

24.5 

9232 

9238 

9244 

9250 

9256 

9262 

9268 

9274 

9280 

9286 

9293 

25.0 

9220 

9226 

9232 

9238 

9244 

9250 

9256 

9262 

9268 

9274 

9281 

25.5 

9207 

9213 

9219 

9225 

9231 

9238 

9244 

9250 

9256 

9262 

9269 

26.0 

9195 

9201 

9207 

9213 

9219 

9226 

9232 

9238 

9244 

9250 

9257 

26.5 

9183 

9189 

9195 

9201 

9207 

9214 

9220 

9226 

9232 

9238 

9245 

27.0 

9171 

9177 

9183 

9189 

9195 

9202 

9208 

9214 

9220 

9226 

9233 

27.5 

9158 

9164 

9170 

9176 

9183 

9190 

9196 

9202 

9208 

9214 

9221 

28.0 

9145 

9151 

9157 

9163 

9170 

9177 

9183 

9189 

9195 

9202 

9208 

28.5 

9132 

9138 

9144 

9150 

9157 

9164 

9170 

9176 

9182 

9188 

9195 

29.0 

9119 

9125 

9131 

9137 

9144 

9151 

9157 

9163 

9169 

9175 

9182 

29.5 

9106 

9112 

9118 

9124 

9130 

9137 

9143 

9149 

9155 

9161 

9168 

30.0 

9093 

9099 

9105 

9111 

9117 

9124 

9130 

9136 

9142 

9148 

9155 

30.5 

9079 

9085 

9091 

9097 

9103 

9110 

9116 

9122 

9128 

9134 

9141 

31.0 

9066 

9072 

9078 

9084 

9090 

9097 

9103 

9109 

9115 

9121 

9128 

31.5 

9052 

9058 

9064 

9070 

9076 

9083 

9089 

9095 

9101 

9107 

9114 

32.0 

9039 

9045 

9051 

9057 

9063 

9070 

9076 

9082 

9088 

9094 

9101 

APPENDIX 


99 


Table  II  (Con't.) 

Log  Factor  for  Reducing  Volume  of  Gases  to  Standard  Temperature 
and  Pressure, Dry;  Including  Reduction  of  Barometric  Height  to 
Standard  Temperature  (brass  scale). 

Barometer  in  Millimeters. 


'Temp. 

°C 

730 

731 

732 

733 

734 

735 

736 

737 

738 

739 

740 

15.0 

1.9505 

9511 

9517 

9523 

.9529 

9535 

9541 

9547 

9553 

9559 

9565 

15.5 

9494 

9500 

9507 

9512 

9518 

9524 

9531 

9536 

9542 

9549 

9554 

16.0 

9484 

9490 

9496 

9502 

9508 

9514 

9520 

9526 

9532 

9538 

9544 

16.5 

9473 

9479 

9485 

9491 

9497. 

9503 

9509 

9515 

9521 

9527 

9533 

17.0 

9463 

9469 

9475 

9481 

9487 

9493 

9499 

9505 

9511 

9517 

9523 

17.5 

9452 

9458 

9464 

9470 

9476 

9483 

9489 

9495 

9500 

9507 

9513 

18.0 

9441 

9447 

9453 

9459 

9465 

9472 

9478 

9484 

9490 

9496 

9502 

18.5 

9430 

9436 

9442 

9448 

9454 

'9461 

9467 

9473 

9479 

9485 

9491 

19.0 

9419 

9425 

9431 

9437 

9443 

9450 

9456 

9462 

9468 

9474 

9480 

19.5 

9409 

9415 

9421 

9427 

9433 

9439 

9445 

9451 

9457 

9463 

9470 

20.0 

9398 

9404 

9410 

9416 

9422 

9428 

9434 

9440 

9446 

9452 

9459 

20.5 

9387 

9393 

9399 

9405 

9411 

9417 

9423 

9429 

9435 

9441 

9448 

21.0 

9375 

9381 

9387 

9393 

9399 

9405 

9411 

9417 

9423 

9429 

9436 

21.5 

9563 

9569 

9375 

9381 

9387 

9393 

9399 

9405 

9411 

9417 

9424 

22.0 

9352 

9358 

9364 

9370 

9376 

9382 

9388 

9394 

9400 

9406 

9413 

22.5 

9341 

9347 

9353 

9359 

9365 

9371 

9377 

9383 

9389 

9395 

9402 

23.0 

9329 

9335 

9341 

9347 

9353 

9359 

9365 

9371 

9377 

9383 

9390 

23.5 

9317 

9323 

9329 

9335 

9342 

9348 

9354 

9360 

9366 

9372 

9379 

24.0 

9305 

9311 

93l7 

9323 

9329 

9336 

9342 

9348 

9354 

9360 

9367 

24.5 

9293 

9299 

9305 

9311 

9317 

9324 

9330 

9336 

9342 

9348 

9355 

25.0 

9281 

9287 

9293 

9299 

9305 

9312 

9318 

9324 

9330 

9336 

9343 

25.5 

9269 

9275 

9281 

9287 

9293 

9300 

9306 

9312 

9318 

9324 

9330 

26.0 

9257 

9263 

9269 

9275 

9281 

9288 

9294 

9300 

9306 

9312 

9318 

36.5 

9245 

9251 

9257 

9263 

9269 

9276 

9282 

9288 

9294 

9300 

9306 

27.0 

9233 

9239 

9245 

9251 

9257 

9264 

9270 

9276 

9282 

9288 

9294 

27.5 

9221 

9227 

9233 

9239 

9245 

9251 

9257 

9263 

9270 

9276 

9285 

28.0 

9208 

9214 

9220 

9226 

9232 

9238 

9244 

9250 

9256 

9262 

9268 

28.5 

9195 

9201 

9207 

9213 

9219 

9225 

9231 

9237 

9243 

9249 

9255 

29.0 

9182 

9188 

9194 

9200 

9206 

9212 

9218 

9224 

9230 

9236 

9243 

29.5 

9168 

9174 

9180 

9186 

9192 

9199 

9205 

9211 

9217 

9223 

9229 

SO.O 

9155 

9161 

9167 

9173 

9180 

9186 

9192 

9198 

9204 

9210 

9216 

30.5 

9141 

9147 

9153 

9159 

9166 

9173 

9179 

9185 

9191 

9197 

9203 

31.0 

9128 

9134 

9140 

9146 

9153 

9160 

9166 

9172 

9178 

9184 

9190 

31.5 

9114 

9120 

9126 

9132 

9139 

9146 

9152 

9158 

9164 

9170 

9176 

32.0 

9101 

9107 

9113 

'9119 

9126 

9133 

9139 

9145 

9151 

9157 

9163 

100 


BASAL  METABOLIC   RATE 


Table  II  (Con't.) 

Log  Factor  for  Reducing  Volume  of  Gases  to  Standard  Temperature 
and  Pressure, Dry;  Including  Seduction  of  Barometric  Height  to 
Standard  Temperature  (brass  scale)* 


Barometer  in  Millimeters. 


Temp. 

°C 

T40 

15.0 

1.9565 

15.5 

9554 

16.0 

9544 

16.5 

9533 

17.0 

9523 

17.5 

9513 

18.0 

9502 

18.5 

9491 

19,0 

9480 

19.5 

9470 

20.0 

9459 

20.5 

9448 

21.0 

9436 

21.5 

9424 

22.0 

9413 

22.5 

9402 

23.0 

9390 

23.5 

9379 

24.0 

9367 

24.5 

9355 

25.0 

9343 

25.5 

9330 

26.0 

9318 

26.5 

9306 

27.0 

9294 

27.5 

9283 

28.0 

9268 

28.5 

9255 

29.0 

9243 

29.5  ' 

9229 

30.0 

9216 

30.5 

9203 

31.0 

9190 

31.5 

9176 

32.0 

9163 

741    742 


743 


744 


9571  9577  9583  9589 

9560  9566  9572  9579 

9550  9556  9562  9569 

9539  9545  9551  9558 

9529  9535  9541  9547 

9519  9525  9531  9537 

9508  9514  9520  9526 

9497  9503  9509  9515 

9486  9492  9498  9504 

9476  9482  9488  9494 

9465  9471  9477  9483 

9454  9460  9466  9472 

9442  9448  9454  9460 

9430  9436  9442  9448 

9419  9425  9431  9437 

9408  9414  9420  9426 

9396  9402  9408  9414 

9385  9391  9397  9403 

9373  9379  9385  9391 

9361  9367  9373  9379 

9349  9354  9360  9366 

9336  9342  9348  9354 

9324  9330  9336  9342 

9312  9318  9324  9330 

9300  9306  9312  9318 

9289  9295  9301  9307 

9274  9280  9286  9292 

9261  9267  9273  9280 

9249  9255  9261  9267 

9236  9242  9248  9254 

9222  9228  9234  9241 

9209  9215  9221  9227 

9196  9202  9208  9214 

9182  9188  9194  9200 

9169  9175  9181  9187 


745  746  747  748  749  750 

9595  9601  9607  9613  9619  9624 

9584  9590  9596  9602  9608  9614 

9574  9580  9586  9592  9598  9603 

9563  9569  9575  9581  9587  9593 

9553  9559  9565  9571  9577  9583 

9542  9548  9554  9560  9566  9572 

9531  9537  9543  9549  9555  9561 

9521  9527  9532  9538  9544  9550 

9510  9516  9522  9528  9534  9540 

9499  9505  9511  9517  9523  9529 

9488  9494  9500  9506  9512  9518 

9477  9483  9489  9495  9501  9507 

9466  9472  9477  9483  9489  9495 

9455  9461  9467  9473  9479  9485 

9443  9449  9455  9461  9467  9473 

9432  9438  9444  9450  9456  9461 

9420  9426  9432  9438  9444  9450 

9408  9414  9420  9426  9432  9438 

9397  9403  9409  9415  9421  9427 

9385  9391  9397  9403  9409  9415 

9373  9379  9385  9391  9397  9403 

9361  9367  9373  9379  9385  9391 

9349  9355  9361  9367  9373  9379 

9337  9343  9349  9355  9361  9367 

9325  9331  9337  9343  9349  9355 

93.13  9319  9325  9331  9337  9342 

9299  9305  9311  9317  9324  9330 

9287  9293  9299  9305  9311  9317 

9274  9280  9286  9292  9298  9304 

9261  9267  9273  9279  9286  9292 

9248  9254.  9260  9266  9272  9278 

S234  9240  9246  9252  9258  9264 

9281  9227  9233  9239  9245  9251 

9207  9213  9219  9225  9231  9238 

9194  9200  9206  9212  9218  9225 


APPENDIX 


101 


Table  ll  (Con't.) 

Log  Factor  for  Reducing  Volume  of  Cases  to  Standard  Temperature 
and  Pressure, Dry:  Including  Reduction  of  Barometric  Height  to 
Standard  Temperature  (brass  scale). 


Barometer  in 

Millimeters. 

Temp. 

°C 

750 

751 

752 

753 

754 

755 

756 

757 

758 

759 

760 

15.0 

1.9624 

9630 

9636 

9642 

9648 

9654 

9660 

9665 

9671 

9677 

9683 

15.5 

9614 

9620 

9626 

9632 

9637 

9643 

9649 

9655 

9661 

9667 

9673 

16.0 

9603 

9609 

9615 

9621 

9627 

9633 

9639 

9645 

9651 

9656 

9662 

16.5 

9593 

9599 

9605 

9611 

9617 

9622 

9628 

9634 

9640 

9646 

9652 

17.0 

9583 

9588 

9594 

9600 

9606 

9612 

9618 

9624 

9630 

9636 

9641 

17.5 

9572 

9578 

9584 

9590 

9595 

9601 

9607 

9613 

9619 

9624 

9630 

18.0 

9561 

9567 

9573 

9579 

9585 

9591 

9596 

9602 

9608 

9614 

9620 

18.5 

9550 

9556 

9562 

9568 

9574 

9580 

S586 

9591 

9597 

9603 

9609 

19.0 

9540 

9546 

9551 

9557 

9563 

9569 

9575 

9581 

9587 

9593 

9598 

19.5 

9529 

S534 

9540 

9546 

9552 

9558 

9564 

9570 

9576 

9582 

9588 

20.0 

9518 

9524 

9530 

9536 

9541 

9547 

9553 

9559 

9565 

9571 

9577 

20.5 

9507 

9513 

9518 

9524 

9530 

9536 

9542 

9548 

9554 

9560 

9566 

21.0 

9495 

9501 

9507 

9513 

9.519 

9525 

9531 

9537 

9542 

9548 

9554 

21.5 

9485 

9491 

9497 

9502 

9508 

9514 

9520 

9526 

9531 

9537 

9543 

22.0 

9473 

9479 

9485 

9491 

9497 

9503 

9509 

9515 

9521 

9526 

9532 

22.5 

9461 

9467 

9473 

9479 

9485 

9491 

9497 

9503 

9509 

9515 

9521 

23.0 

9450 

9456 

9462 

9468 

9474 

9480 

9486 

9492 

9498 

9503 

9509 

23.5 

9438 

9444 

9450 

9456 

9462 

9468 

9474 

9480 

9486 

9492 

9498 

24.0 

9427 

9433 

9439 

9445 

9451 

9456 

9462 

9468 

9474 

9480 

9486 

24.5 

9415 

9421 

9427 

9433 

9439 

9445 

9451 

9457 

9463 

9468 

9474 

25.0 

•9403 

9409 

9415 

9421 

9427 

9433 

9439 

9445 

9450 

9456, 

9462 

25.5 

9391 

9397 

9403 

9409 

9415 

9421 

9427 

9433 

9439 

9445 

9450 

26.0 

9379 

9385 

9391 

9397 

9403 

9409 

9415 

9421 

9427 

9433 

9439 

26.5 

9367 

9373 

9379 

9385 

9390 

9396 

9402 

9408 

9414 

9420 

9426 

27.0 

9355 

9361 

9367 

9373 

9379 

9385 

9391 

9397 

9403 

9409 

9415 

27.5 

9342 

9348 

9354 

9360 

9366 

9372 

9378 

9384 

9390 

9396 

9402 

28.0 

9330 

9336 

9342 

9348 

9354 

9360 

9366 

9372 

9377 

9383 

9389 

28.5 

9317 

9323 

9329 

9335 

9341 

9347 

9353 

9359 

9365 

9371 

9377 

29.0 

9304 

9310 

9316 

9322 

9328 

9334 

9340 

9346 

9352 

9358 

9364 

29.5 

9292 

9298 

9304 

9310 

9316 

9322 

9328 

9534 

9340 

9346 

9351 

30.0 

9278 

9284 

9290 

9297 

9303 

9309 

9315 

9321 

9327 

9333 

9339 

30.5 

9264 

9270 

9276 

9282 

9288 

9295 

9301 

9307 

9313 

9319 

9325 

31.0 

9251 

9257 

9263 

9269 

9275 

9282 

9288 

9294 

9300 

9306 

9312 

31.5 

9238 

9244 

9250 

9256 

9262 

9268 

9274 

9280 

9286 

9292 

9298 

32.0 

9225 

9231 

9237 

9243 

9249 

9255 

9261 

9267 

9273 

9279 

9285 

102 


BASAL  METABOLIC  RATE 


Table  II  (Con't.J 

Log  Factor  for  Reducing  Volume,  of  Gases  to  Standard  Temperature 
and  Pressure, Dry;  Including  Reduction  of  Barometric  Height  to 
Standard  Temperature  (brass  scale). 


Barometer  in  Millimeters, 


Terap. 

(0C 

760 

15.0 

1.9683 

15.5 

9673 

16.0 

9662 

16.5 

9652 

17.0 

9641 

17.5 

9630 

18.0 

9620 

18.5 

9609 

19.0 

9598 

19.5 

9588 

20.0 

9577 

20.5 

9566 

31.0 

9554 

21.5 

9543 

22.0 

9532 

22.5 

9521 

23.0 

9509 

23.5 

9498 

24.0 

9486 

24*5 

9474 

25.0 

9462 

25.5 

9450 

26.0 

9439 

26.5 

9426 

.27.0 

9415 

27.5 

9402 

28.0 

9389 

28.5 

9377 

29.0 

9364 

29.5 

9351 

'30.0 

9339 

30.5 

9325 

31.0 

9312 

51.5 

9298 

32.0 

9285 

761  762  763  764  765 

9688  9694  9700  9706  9712 

9678  9684  9690  9696  9702 

9668  9674  9680  9685  9691 

9658  9663  9669  9674  9680 

9647  9653  9659  9665  9670 

9636  9642  9648  9654  9659 

9626  9632  9637  9643  9649 

9615  9621  9626  9632  9638 

9604  9610  9616  9621  9627 

9593  9599  9605  9611  9617 

9582  9588  9594  9600  9606 

9572  9577  9583  9589  9594 

9560  9566  9572  9578  9583 

9549  95'55  9561  9567  9573 

9538  9544  9550  9556  9562 

9527  9533  9538  9544  9550 

9515  9521  9~526  9532  9538 

9504  9510  9516  9521  9527 

9492  9498  9504  9509  9515 

9480  9486  9492  9498  9503 

9468  9474  9480  9486  9492 

9456  9462  9468  9474  9480 

9445  9451  9457  9463  9468 

9432  9438  9444  9450  9456 

9421  9427  9432  9438  9444 

9408  9414  9420  9426  9432 

9395  9401  9407  9413  9419 

9383  9389  9395  9401  9407 

9370  9376  9382  9388  9394 

9357  9363  9369  9375  9381 

9345  9351  9357  9363  9369 

9331  9337  9343  9349  9355 

9318  9324  9330  9336  9342 

9304  9310  9316  9322  9328 

9291  9297  9303  9309  '9315 


766    767 


768 


769 


9717  9723  9729  S735 

9707  9713  9719  9725 

9697  9703  9709  9714 

9686  9692  9698  9703 

9676  9682  9688  9694 

9665  9671  9677  9683 

9655  9660  9666  9672 

9644  9650  9655  9661 

9633  9639  9645  9650 

9623  9628  9634  9640 

9612  9618  9623  9629 

9600  9606  9612  9618 

9589  9595  9601  9607 

9578  9584  9590  9596 

9568  9573  9579  9584 

9556  9562  9568  9574 

9544  9550  9556  9562 

9533  9539  9545  9551 

9521  9527  9533  9539 

9509  9515  9521  9527 


770 

9740 
9731 
9720 
9709 
9699 

9688 
9677 
9667 
9656 
9645 

9635 
9623 
9613 
9602 
9590 

9579 
9567 
9556 
9545 
9533 


9498  9504  9509  9515  9521 

9486  9492  9497  9503  9509 

9474  9480  9485  9491  9497 

9462  9468  9473  9479  9485 

9450  9456  94,62  9467  9473 

9438  9444  9450  9455  9461 

9425  9431  9436  9442  9448 

9412  9418  9424  9430  9436 

9400  9406  9411  9417  9423 

9387  9393  9399  9405  9411 

9375  9380-  9386  9392  9398 

9361  9367  9373  9379  9385 

9348  9354  9360  9366  9372 

9334  9340  9346  9352  9358 

9321  9327  9333  9339  9345 


APPENDIX 


103 


Table  II  (Con't.) 

Log  Factor  for  Reducing  Volume  of  Gases  to  Standard  Temperature 
and  Pressure, Dry;  Including  Reduction  of  Barometric  Height  to 
Standard  Temperature  (brass  scale). 


Barometer  in  Millimeters, 


Temp. 

°C 

770 

771 

772 

773 

774 

775 

15.0 

1.9740 

9746 

9752 

9758 

9763 

9769 

15.5 

9731 

9736 

9742 

9748 

9753 

9759 

16.0 

9720 

9726 

9732 

9737 

9743 

9749 

16.5 

9709 

9715 

9721 

9726 

9732 

9738 

17.0 

9699 

9705 

9711 

9717 

9722 

9728 

17.5 

9688 

9694 

9700 

9706 

9711 

9717 

18.0 

9677 

9683 

9689 

9695 

9700 

9706 

18*5 

9667 

9673 

9679 

9684 

9690 

9696 

19.0 

9656 

9662 

9668 

9674 

9679 

9685 

19.5 

9645 

9651 

9657 

9663 

9668 

9674 

20.0 

9635 

9641 

9646 

9652 

9658 

9664 

20.5 

9623 

9629 

9635 

9641 

9647 

9652 

21.0 

9613 

9618 

96.24 

9630 

9636 

9641 

21.5 

9602 

9608 

9613 

9619 

9625 

9631 

22.0 

9590 

9596 

9602 

9608 

9613 

9619 

22.5 

9579 

9585 

9591 

9597 

9603 

9608 

23.0 

9567 

9573 

9579 

9585 

9591 

9596 

23.5 

9556 

9562 

9568 

9573 

9579 

9585 

24.0 

9545 

9550 

9556 

9562 

9568 

9574 

24.5 

9533 

9538 

9544 

9550 

9556 

9562 

25.0 

9521 

9527 

9533 

9539 

9545 

9550 

25.5 

9509 

9515 

9521 

9527 

9533 

9538 

26.0 

9497 

9503 

9509 

9515 

9521 

9526 

26.5 

9485 

9491 

9497 

9503 

9509 

9514 

27.0 

9473 

9479 

9485 

9491 

9497 

9503 

27.5 

9461 

9467 

9472 

9478 

9484 

9490 

28.0 

9448 

9454 

9460 

9466 

9472 

9478 

28.5 

9436 

9442 

9448 

9453 

9459 

9465 

29.0 

9423 

9429 

9435 

9441 

9446 

9452 

29.5 

9411 

9417 

9423 

9428 

9434 

9440 

30.0 

9398 

9404 

9409 

9415 

9421 

9427 

30.5 

9385 

9391 

9397 

9402 

9409 

9414 

31.0 

9372 

9378 

9384 

9390 

9396 

9401 

31.5 

9358 

9364 

9370 

9376 

9382 

9387 

32.0 

9345 

9351 

9357 

9363 

9369 

9374 

776    777    778    779 


780 


9775  9780  9786  9792  9798 

9764  9770  9776  9781  9787 

9755  9760  9766  9772  9777 

9744  9749  9755  9761  9766 

9734  9740  9745  9750  9756 

9723  9729  9735  9740  9746 

9712  9718  9723  9729  9735 

9702  9707  9713  9719  9724 

9691  9696  9702  9708  9714 

9680  9686  9691  9697  9703 

9670  9675  9681  9687  9692 

9658  9664  9670  9675  9681 

9647  9652  9658  9664  9670 

9636  9642  9648  9654  9659 

9625  9631  9636  9642  9648 

9614  9620  9625  9631  9637 

9602  9608  9614  9619  9625 

9591  9596  9602  9608  9614 

9579  9585  9591  9597  9602 

9567  9573  9579  9585  9591 

9556  9561  9567  9573  9579 

9544  9550  9556  9562  9567 

9532  9538  9544  9550  9555 

9520  9526  9531  9537  6543 

9508  9514  9520  9526  9532 

9496  9502  9508  9513  9519 

9483  9489  9495  9501  9506 

9471  9477  9483  9488  9494 

9458  9464  9470  9475  9481 

9446  9452  9458  9464  9469 

9433  9439  9445  9451  9456 

9420  9426  9432  9438  9443 

9407  9413  9419  9425  9430 

9393  9399  9405  9411  9416 

9380  9386  9392  9397  9403 


Table  III. — The  oxygen  percentages  of  the  inspired  air  are  cor- 
rected to  the  basis  of  the  expired  volume  as  explained  on  page  84. 
The  corrected  oxygen  percentage  is  equal  to  20.93  X  =^,  where  x 


is  the  percentage  of  nitrogen  of  the  expired  air  which  is  equal  to 


104 


BASAL  METABOLIC   RATE 


100  per  cent,  minus  (CO2  +  Oz)  per  cent,  of  the  expired  air.  In- 
stead of  tabulating  the  various  nitrogen  percentages  we  use  the  sum 
of  the  carbon  dioxid  and  oxygen  percentages  of  the  expired  air,  sav- 
ing the  step  of  deriving  the  nitrogen  values.  In  case  room  air  is 
used  the  values  for  the  correction  of  the  inspired  oxygen  percentage 
given  in  this  table  can  be  utilized  by  subtracting  from  them  the  dif- 
ference between  the  percentage  of  oxygen  in  outdoor  air  (20.93)  and 
the  percentage  of  oxygen  in  the  inspired  room  air. 

Table  III. 
Correct  ion  Inspired  Oxygen  Percentage  to  Basis  of  Expired  Volume. 


.00 


.01 


.02 


.03 


.04 


.05 


,06 


.07 


.08 


>09 


19.5 

21.32 

21.32 

21.31 

21.31 

21.31 

21.31 

21.30 

21.30 

21.30 

21.30 

19.6 

21.29 

21.29 

21.29 

21.28 

21.28 

21.28 

21.28 

21.27 

21.27 

21.27 

19.7 

21.27 

21.26 

21.26 

21.26 

21.26 

21.25 

21.25 

21.25 

21.25 

21.24 

19.8 

21.24 

21.24 

21.24 

21.23 

21.23 

21.23 

21.22 

21.22 

21.22 

21.22 

19.9 

21.21 

21.21 

21.21 

21.21 

21.20 

21.20 

21.20 

21.20 

21.19 

21.19 

20.0 

21.19 

21.18 

21.18 

21.18 

21.18 

21.17 

21.17 

21.17 

21.17 

21.16 

20.1 

21.16 

21.16 

21.16 

21.15 

21.15 

21.15 

21.15 

21.14 

21.14 

21.14 

20.2 

21.13 

21.13 

21.13 

21.13 

21.12 

21.12 

21.12 

21.12 

21.11 

21.11 

20*5 

21.11 

21.10 

21.10 

21.10 

21.10 

21.09 

21.09 

21.09 

21.09 

21.08 

20.4 

21.08 

21.08 

21.08 

21.07 

21.07 

21.07 

21.07 

21.06 

21.06 

21.06 

20.5 

21.05 

'21.05 

21.05 

21.05 

21,04 

21.04 

21.04 

21.04 

21.03 

21.03 

20.6 

21.03 

21.03 

21.02 

21.02 

21.02 

21.02 

21.01 

21.01 

21.01 

21.00 

20.7 

21.00 

21.00 

21.00 

20.99 

20.99 

.20.99 

20.99 

20.98 

20.98 

20.98 

20.8 

20.98 

20.97 

20.97 

20.97 

20.96 

20.96 

20.96 

20.96 

20.95 

20.95 

20.9 

20.95 

20.95 

20.94 

20.94 

20.94 

20.94 

20.93 

20.93 

20.93 

20.93 

21.0 

20.92 

20.92 

20.92 

20.91 

20.91 

20.91 

20.91 

20,90 

20.90 

20.90 

21.1 

20.90 

20.89 

20.89 

20.89 

20.89 

20.88 

20.88 

20.88 

20.87 

20.87 

21.2 

20.87 

20.87 

20.-86 

20.86 

20.86 

20.86 

20.85 

20.85 

20.85 

20.85 

Table  IV. — The  logarithms  of  the  calorific  values  of  1  liter  of 
oxygen  are  given  for  various  respiratory  quotients,  plus  the  log  of 
sixty  minutes.  We  have  taken  Zuntz  and  Schumburg's  calorie 
tables  and  to  the  log  of  the  various  factors  given  by  them  have 
added  the  log  of  60  in  order  to  change  in  this  single  process  the 
time  period  from  one  minute  to  one  hour.  For  example,  for  a  non- 
protein  respiratory  quotient  of  0.85,  the  calorific  value  of  1  liter  of 


APPENDIX 


105 


oxygen  is  4.863,  the  log  of  which  is  0.68690,  and  to  this  is  added  the 
log  of  60  minutes: 

Log  4.863     =     0.68690 
Log  60         =     1.77815 

2.46505     =     0.4651     +     2 
Table  IV. 


Calorific  Value  of  One  Liter  of  Oxygen  for  Various  (Non-Protein) 

Respiratory  Quotients  together  with  the  Log  of  the  Calorific 

Value  to  which  is  Added  the  Log  of  60  Minutes* 


R.Q. 


0.707 
•71 
.72 
.73 
.74 

.75 
.76 
.77 
.78 
.79 

.80 
.81 
.82 
.85 

•  84 

•  85 
.86 
.87 


.90 
.91 
.92 
.93 
.94 

.95 
•96 
.97 
.98 
.99 


Calories  for  1  Liter 
of  Oxygen 

4.686 
4.690 
4.702 
4.714 
4.727 

4.739 
4.752 
4.764 
4.776 
4.789 

4.801 
4.813 
4.825 
4.838 
4.850 

4.863 
4.875 
4.887 
4.900 
4»912 

4.924 
4.936 
4.948 
4.960 
4.973 

4.985 
4.997 
5.010 
5.022 
5.034 


Log  Calories  P'lus 
Log  60 

2-.4490 
4494 
4505 
4517 
4528 

4539 
4551 
4562 
4573 
4584 

4596 
4607 
4618 
4629 
4640 

4651 
4662 
4673 
4684 
4695 

4705 
4716 
4727 
4738 
4748 

4759 
4770 
4781 
4791 
4802 


1.00 


5.047 


4813 


106  BASAL   METABOLIC   RATE 

Table  V—  Du  Bois  "height-weight  chart."34 


APPENDIX 


I07 


Table  VI. — The  normal  standards  for   comparison,  published 
by  Aub  and  Du  Bois. 

Table  VI. 

Standards  of  Normal  Metabolism 
Average  Calories  Per  Hour  Per  Square  Meter  of  Body  Surface  (Du  Bois). 


Age 
(Years) 


16-18 
18-20 
20-30 
30-40 
40-50 
50-60 
60-70 
70-80 


Males 
Cals. 

46.0 
43.0 
41.0 
39.5 
39.5 
38.5 
37.5 
36.5 
35.5 


Log  Cals, 


1.6628 
6335 
6128 
5966 
5966 
5855 
5740 
5623 
5502 


Females 
Cals. 

43.0 
40.0 
38.0 
37.0 
36.5 
36.0 
35.0 
34.0 
33.0 


Log  Cals, 


1.6335 
6021 
5798 
5682 
5623 
5563 
5441 
5315 
5185 


Table  VII. — Four  place  logarithms. 


Table  VII. 

Four  Place  Logarithms. 
3456 


10 


1.00 

0.0000 

0004 

0009 

0013 

0017 

0022 

0026 

0030 

0035 

0039 

0043 

1.01 

0043 

0048 

0052 

0056 

0060 

0065 

0069 

0073 

0077 

0082 

0086 

1.02 

0086 

0090 

0095 

0099 

0103 

0107 

0111 

0116 

0120 

0124 

0128 

1.03 

0128 

0133 

0137 

0141 

0145 

0149 

0154 

0158 

0162 

0166 

0170 

1.04 

0170 

0175 

0179 

0183 

0187 

0191 

0195 

0199 

0204 

0208 

0212 

1.05 

0212 

0216 

0220 

0224 

0228 

0233 

0237 

0241 

0245 

0249 

0253 

1.06 

0253 

0257 

0261 

0265 

0269 

0273 

0278 

0282 

0286 

0290 

0294 

1;07 

0294 

0298 

0302 

0306 

0310 

0314 

0318 

0322 

0326 

0330 

0334 

1.08 

0334 

0338 

0342 

0346 

0350 

0354 

0358 

0363 

0366 

0370 

0374 

1.09 

0374 

0378 

0382 

0386 

0390 

0394 

0398 

0402 

0406 

0410 

0414 

1.10 

0.0414 

0418 

0422 

0426 

0430 

0434 

0438 

0441 

0445 

0449 

0453 

1.11 

0453 

0457 

0461 

0465 

0469 

0473 

0477 

0481 

0484 

0488 

0492 

1.12 

0492 

0496 

0500 

0504 

0508 

0512 

0515 

0519 

0523 

0527 

0531 

1.13 

0531 

0535 

0538 

0542 

0546 

0550 

0554 

0558 

0561 

0565 

0569 

1.14 

0569 

0573 

0577 

0580 

0584 

0588 

0592 

0596 

0599 

0603 

0607 

,1.15 

0607 

0611 

0615 

0618 

0622 

0626 

0630 

0633 

0637 

0641 

0645 

1.16 

0645 

0648 

0652 

0656 

0660 

0663 

0667 

0671 

0674 

0678 

0682 

1.17 

0682 

0686 

0689 

0693 

0697 

0700 

0704 

0708 

0711 

0715 

0719 

1.18 

0719 

0722 

0726 

0730 

0734 

0737 

0741 

0745 

0748 

0752 

0755 

1.19 

0755 

0759 

0763 

0766 

0770 

0774 

0777 

0781 

0785 

0788 

0792 

1.20 

0.0792 

0795 

0799 

0803 

0806 

0810 

0813 

0817 

0821 

0824 

0828 

1.21 

0828 

0831 

0835 

0839 

0842 

0846 

0849 

0853 

0856 

0860 

0864 

1.22 

0864 

0867 

0871 

0874 

0878 

0881 

0885 

0888 

0892 

0896 

0899 

1.23 

0899 

0903 

0906 

0910 

0913 

0917 

0920 

0924 

0927 

0931 

0934 

1.24 

0934 

0938 

0941 

0945 

0948 

0952 

0955 

0959 

0962 

0966 

0969 

1.25 

0969 

0973 

0976 

0980 

0983 

0986 

0990 

0993 

0997 

1000 

1004 

1.26 

1004 

1007 

1011 

1014 

1017 

102  1 

1024 

1038 

1031 

1035 

1038 

1.27 

1038 

1041 

1045 

1048 

1052 

1055 

1059 

1062 

1065 

1069 

1072 

1.28 

1072 

1075 

1079 

1082  , 

1086 

1089 

1092 

1096 

1099 

1103 

1106 

1.29 

1106 

1109 

1113 

1116 

1119 

1123 

1126 

1129 

1133 

1136 

1139 

1.30 

0.1139 

1143 

1146 

1149 

1153 

1156 

1159 

1163 

1166 

1169 

1173 

1.31 

1173 

1176 

1179 

1183 

1186 

1189 

1193 

1196 

1199 

1202 

1206 

1.32 

1206 

1209 

1212 

1216 

1219 

1222 

1225 

1229 

1232 

1235 

1239 

1.33 

1239 

1242 

1245 

1248 

1252 

1255 

1258 

1261 

1265 

1268 

1371 

1.34 

1271 

1274 

1278 

1281 

1284 

1287 

1290 

1294 

1297 

1300 

1303 

1.35 

1303 

1307 

1310 

1313 

1316 

1319 

1323 

1326 

1329 

1332 

1335 

1.36 

1335 

1339 

1342 

1345 

1348 

1351 

1355 

1358 

1361 

1364 

1367 

1.37 

1367 

1370 

1374 

1377 

1380 

1383 

1386 

1389 

1392 

1396 

1399 

1.38 

1399 

1402 

1405 

1408 

1411 

1414 

1418 

1431 

1424 

1427 

1430 

1.39 

1430 

1433 

1436 

1440 

1443 

1446 

1449 

1452 

1455 

1458 

1461 

1.40 

0.1461 

1464 

1467 

1471 

1474 

1477 

1480 

1483 

1486 

1489 

1493 

1.41 

1492 

1495 

1498 

1501 

1504 

1508 

1511 

1514 

1517 

1520 

1523 

1.42 

1523 

1526 

1529 

1532 

1535 

1538 

1541 

1544 

1547 

1550 

1553 

1.43 

1553 

1556 

1559 

1562 

1565 

1569 

1572 

1575 

1578 

1581 

1584 

1.44 

1584 

1587 

1590 

1593 

1596 

1599 

1602 

1605 

1608 

1611 

1614 

1.45 

1614 

1617 

1620 

1623 

1626 

1629 

1632 

1635 

1638 

1641 

1644 

1.46 

1644 

1647 

1649 

1652 

1655 

1658 

1661 

1664 

1667 

1670 

1673 

1.47 

1673 

1676 

1679 

1682 

1685 

1688 

1691 

1694 

1697 

1700 

1703 

1.48 

1703 

1706 

1708 

1711 

1714 

1717 

1720 

1723 

1726 

1729 

1732 

1.49 

1732 

1735 

1738 

1741 

1744 

1746 

1749 

1752 

1765 

1758 

1761 

108 


Table  VII.    (Con't.) 
Four  Place  Logarithms, 
3456 


10 


1.50 

0.1761 

1764 

1767 

1770 

1772 

1775 

1778 

1781 

1784 

1787 

1790 

1.51 

1790 

1793 

1796 

1798 

1801 

1804 

1807 

1810 

1813 

1816 

1813 

1.52 

1818 

1821 

1824 

1827 

1830 

1833 

1836 

1838 

1841 

1844 

1847 

1.53 

1847 

1850 

1853 

1855 

1858 

1861 

1864 

1867 

1870 

1872 

1875 

1.54 

1875 

1878 

1881 

1884 

1886 

1889 

1892 

1895 

1898 

1901 

1903 

1.55 

1903 

1906 

1909 

1912 

1915 

1917 

1920 

1923 

1926 

1928 

1931 

1.56 

1931 

1934 

1937 

1940 

1942 

1945 

1948 

1951 

1953 

1956 

1959 

1.57 

1959 

1962 

1965 

1967 

1970 

1973 

1976 

1978 

1981 

1984 

1987 

1.58 

1987 

1989 

1992 

1995 

1998 

2000 

2003 

2006 

2009 

2011 

2014 

1.59 

2014 

2017 

2019 

2022 

2025 

2028 

2030 

2033 

2036 

2038 

2041 

1.60 

0.2041 

2044 

2047 

2049 

2052 

2055 

2057 

2060 

2063 

2066 

2068 

1.61 

2068 

2071 

2074 

2076 

2079 

2082 

2084 

2087 

2090 

2092 

2095 

1.62 

2095 

2098 

2101 

2103 

2106 

2109 

2111 

2114 

2117 

2119 

2122 

1.63 

2122 

2125 

2127 

2130 

2133 

2135 

2138 

2140 

2143 

2146 

2148 

1.64 

2148 

2151 

2154 

2156 

2159 

2162 

2164 

2167 

2170 

2172 

2175 

1.65 

2175 

2177 

2180 

2183 

2185 

2188 

2191 

2193 

2196 

2198 

2201 

1.66 

2201 

2204 

2206 

2209 

2212 

2214 

2217 

2219 

2222 

2225 

2227 

1.67 

2227 

2230 

2232 

2235 

2238 

2240 

2243 

2245 

2248 

2251 

2253 

1.68 

2253 

2256 

2258 

2261 

2263 

2266 

2269 

2271 

2274 

2276 

2279 

1.69 

2279 

2281 

2284 

2287 

2289 

2292 

2294 

2297 

2299 

2302 

2304 

1.70 

0.2304 

2307 

2310 

2312 

2315 

2317 

2320 

2322 

2325 

2327 

2330 

1.71 

2330 

2333 

2335 

2338 

2340 

2343 

2345 

2348 

2350 

2353 

2355 

1.72 

2355 

2358 

2360 

2363 

2365 

2368 

2370 

2373 

2375 

2378 

2380 

1.73 

2380 

2383 

2385 

2388 

2390 

2393 

2395 

2398 

2400 

2403 

2405 

1.74 

2405 

2408 

2410 

2413 

2415 

2418 

2420 

2423 

2425 

2428 

2430 

1.75 

2430 

2433 

2435 

2438 

2440 

2443 

2445 

2448 

2450 

2453 

2455 

1.76 

2455 

2458 

2460 

2463 

2465 

2467 

2470 

2472 

2475 

2477 

2480 

1.77 

2480 

2482 

2485 

2487 

2490 

2492 

2494 

2497 

2499 

2502 

2504 

1.78 

2504 

2507 

2509 

2512 

2514 

2516 

2519 

2521 

2524 

2526 

2529 

1.79 

2529 

2531 

2533 

2536 

2538 

2541 

2543 

2545 

2548 

2550 

2553 

1.80 

0.2553 

2555 

2558 

2560 

2562 

2565 

2567 

2570 

2572 

2574 

2577 

1.81 

2577 

2579 

2582 

2584 

2586 

2589 

2591 

2594 

2596 

2598 

2601 

1.82 

2601 

2603 

2605 

2608 

2610 

2613 

2615 

2617 

2620 

2622 

2625 

1.83 

2625 

2627 

2629 

2632 

2634 

2636 

2639 

2641 

2643 

2646 

2648 

1.84 

2648 

2651 

2653 

2655 

2658 

2660 

2662 

2665 

2667 

2669 

2672 

1.85 

2672 

2674 

2676 

2679 

2681 

2683 

2686 

2688 

2690 

2693 

2695 

1.86 

2695 

2697 

2700 

2702 

2704 

2707 

2709 

2711 

2714 

2716 

2718 

1.87 

2718 

2721 

2723 

2725 

2728 

2730 

2732 

2735 

2737 

2739 

2742 

1.88 

2742 

2744 

2746 

2749 

2751 

2753 

2755 

2758 

2760 

2762 

2765 

1.89 

2765 

2767 

2769 

2772 

2774 

2776 

2778 

2781 

2783 

2785 

2788 

1.90 

0.2788 

2790 

2792 

2794 

2797 

2799 

2801 

2804 

2806 

2803 

2810 

1.91 

2810 

2813 

2815 

2817 

2819 

2822 

2824 

2826 

2828 

2831 

2833. 

1.92 

2833 

2835 

2838 

2840 

2842 

2844 

2847 

2849 

2851 

2853. 

2856 

1.93 

2856 

2858 

2860 

2862 

2865 

2867 

2869 

2871 

2874 

2876 

2878 

1.94 

2878 

2880 

2882 

2885 

2887 

2889 

2891 

2894 

2896 

E898 

2900 

1.95 

2900 

2903 

2905 

2907 

2909 

2911 

2914 

2916 

2918 

2920 

2923 

1.96 

2923 

2925 

2927 

2929 

2931 

2934 

2936 

2938 

2940 

2942 

2945 

1.97 

2945 

2947 

2949 

2951 

2953 

2956 

2958 

2960 

2962 

2964 

2967 

1.98 

2967 

2969 

2971 

2973 

2975 

2978 

2980 

2982 

2984 

2986 

2989 

1.99 

2989 

2991 

2993 

2995 

2997 

2999 

3002 

3004 

3006 

3008 

3010 

109 


no 


BASAL   METABOLIC   RATE 


Table  VII.   (Con't.) 
Four  Place  Logarithms, 


Interpolation* 

0 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

1 

2 

3 

4 

5 

2.0 

0.3010 

3032 

3054 

3075 

3096 

3118 

3139 

3160 

3181 

3201 

3222 

2 

4 

6 

8 

11 

2.1 

3222 

3243 

3263 

3284 

3304 

3324 

3345 

3365 

3385 

3404 

3424 

2 

4 

6 

8 

10 

2.2 

3424 

3444 

3464 

3483 

3502 

3522 

3541 

3560 

3579 

3598 

3617 

2 

4 

6 

8 

10 

2.3 

3617 

3636 

3655 

3674 

3692 

3711 

3729 

3747 

3766 

3784 

3802 

2 

4 

5 

7 

9 

2.4 

3802 

3820 

3838 

3856 

3874 

3892 

3909 

3927 

3945 

3962 

3979 

2 

4 

5 

7 

9 

2.5 

3979 

3997 

4014 

4031 

4048 

4065 

4082 

4099 

4116 

4133 

4150 

2 

3 

5 

7 

9 

2.6 

4150 

4166 

4183 

4200 

4216 

4232 

4249 

4265 

4281 

42.98 

4314 

2 

3 

5 

7 

8 

2.7 

4314 

4330 

4346 

4362 

4378 

4393 

4409 

4425 

4440 

4456 

4472 

2 

3 

5 

6 

8 

2.8 

4472 

4487 

4502 

4518 

4533 

4548 

4564 

4579 

4594 

4609 

4624 

2 

3 

5 

6 

8 

2.9 

4624 

4639 

4654 

4669 

4683 

4698 

4713 

4728 

4742 

4757 

4771 

1 

3 

4 

6 

7 

3.0 

0.4771 

4786 

4800 

4814 

4829 

4843 

4857 

4871 

4886 

4900 

4914 

1 

3 

4 

6 

7 

3.1 

4914 

4928 

4942 

4955 

4969 

4983 

4997 

5011 

5024 

5038 

5051 

1 

3 

4 

6 

7 

3.2 

5051 

5065 

5079 

5092 

5105 

5119 

5132 

5145 

5159 

5172 

5185 

1 

3 

4 

5 

7 

3.3 

5185 

5198 

5211 

5224 

5237 

5250 

5263 

5276 

5289 

5302 

5315 

1 

3 

4 

5 

6 

3.4 

5315 

5328 

5340 

5353 

5366 

5378 

5391 

5403 

5416 

5428 

5441 

1 

3 

4 

5 

6 

5.5 

5441 

5453 

5465 

5478 

5490 

5502 

5514 

5527 

5539 

5551 

5563 

1 

2 

4 

5 

6 

3.6 

5563 

5575 

5587 

5599 

5611 

5623 

5635 

5647 

5658 

5670 

5682 

1 

2 

4 

5 

6 

3.7 

5682 

5694 

5705 

5717 

5729 

5740 

5752 

5763 

5775 

5786 

5798 

1 

2 

3 

5 

6 

3.8 

5798 

5809 

5821 

5832 

5843 

5855 

5866 

5877 

5888 

5899 

5911 

1 

2 

3 

5 

6 

3.9 

5911 

5922 

5933 

5944 

5955 

5966 

5977 

5988 

5999 

6010 

6021 

1 

2 

3 

4 

6 

4.0 

0.6021 

6031 

6042 

6053 

6064 

6075 

6085 

6096 

6107 

6117 

6128 

1 

2 

3 

4 

5 

4.1 

6128 

6138 

6149 

6160 

6170 

6180 

6191 

6201 

6212 

6222 

6232 

1 

2 

3 

4 

5 

4.2 

6232 

6243 

6253 

6263 

6274 

6284 

6294 

-6304 

6314 

6325 

6335 

1 

2 

3 

4 

5 

4.3 

6335 

6345 

6355 

6365 

6375 

6385 

6395 

6405 

6415 

6425 

6435 

1 

2 

3 

4 

5 

4.4 

6435 

6444 

6454 

6464 

6474 

6484 

6493 

6503 

6513 

6522 

6532 

1 

2 

3 

4 

5 

4.5 

6532 

6542 

6551 

6561 

6571 

6580 

6590 

6599 

6609 

6618 

6628 

1 

2 

3 

4 

5 

4.6 

6628 

6637 

6646 

6656 

6665 

6675 

6684 

6693 

6702 

6712 

6721 

1 

2 

•3 

4 

5 

4.7 

6721 

6730 

6739 

6749 

6758 

6767 

6776 

6785 

6794 

6803 

6812 

1 

2 

3 

4 

5 

4.8 

6812 

6821 

6830 

68J39 

6848 

6857 

6866 

6875 

6884 

6893 

6902 

1 

2 

3 

4 

4 

4.9 

6902 

6911 

6920 

6928 

6937 

6946 

6955 

6964 

6972 

6981 

6990 

1 

2 

9 

4 

4 

5.0 

0.6990 

6998 

7007 

7016 

7024 

7033 

7042 

7050 

7059 

7067 

7076 

1 

2 

3 

3 

4 

5.1 

7076 

7084 

7093 

7101 

7110 

7118 

7126 

7135 

7143 

7152 

7160 

1 

2 

3 

3 

4 

5.2 

7160 

7168 

7177 

7185 

7193 

7202 

7210 

7218 

7226 

7235 

7243 

1 

2 

2 

3 

4 

5.3 

7245 

7251 

7259 

7267 

7275 

7284 

7292 

7300 

7308 

7316 

7324 

1 

2 

2 

3 

4 

5.4 

7324 

7332 

7340 

7348 

7356 

7364 

7372 

7380 

7388 

7396 

7404 

1 

2 

2 

3 

4 

5.5 

7404 

7412 

7419 

7427 

7435 

7443 

7451 

7459 

7466 

7474 

7482 

1 

2 

2 

3 

4 

5.6 

7482 

7490 

7497 

7505 

7513 

7520 

7528 

7536 

7543 

7551 

7559 

1 

2 

2 

3 

-4 

5.7 

7559 

7566 

7574 

7582 

7589 

7597 

7604 

7612 

7619 

7627 

7634 

1 

2 

2 

3 

4 

5.8 

7634 

7642 

7649 

7657 

7664 

7672 

7679 

7686 

7694 

7701 

7709 

1 

1 

2 

3 

4 

5.9 

7709 

7716 

7723 

7731 

7738 

7745 

7752 

7760 

7767 

7774 

7782 

1 

1 

2 

3 

4 

APPENDIX 


III 


Table  VII.    (Con't.) 
Four  Place  Logarithms. 


Interpolations 

0 

1 

2 

3 

4 

5 

6 

7 

8 

9 

10 

1 

2 

3 

4 

5 

6.0 

0.7782 

7789 

7796 

7803 

7810 

7818 

7825 

7832 

7839 

7846 

7853 

1 

1 

2 

3 

4 

6.1 

7853 

7860 

7868 

7875 

7882 

7889 

7896 

7903 

7910 

7917 

7924 

1 

1 

2 

3 

4 

6.2 

7924 

7931 

7938 

7945 

7952 

7959 

7966 

7973 

7980 

7987 

7993 

1 

1 

2 

3 

3 

6.3 

7993 

8000 

8007 

8014 

8021 

8028 

8035 

8041 

8048 

8055 

8062 

1 

1 

2 

3 

3 

6.4 

8062 

8069 

8075 

8082 

8089 

8096 

8102 

8109 

8116 

8122 

8129 

1 

1 

2 

3 

3 

6.5 

8129 

8136 

8142 

8149 

8156 

8162 

8169 

8176 

8182 

8189 

8195 

1 

1 

2 

3 

3 

6.6 

8195 

8202 

8209 

8215 

8222 

8228 

8235 

8241 

8248 

8254 

8261 

1 

1 

2 

3 

3 

6.7 

8261 

8267 

8274 

8280 

8287 

8293 

8299 

8306 

8312 

8319 

8325 

1 

1 

2 

3 

3 

6.8 

8325 

8331 

8338 

8344 

8351 

8357 

8363 

8370 

8376 

8382 

8388 

1 

1 

2 

3 

3 

6.9 

8388 

8395 

8401 

8407 

8414 

8420 

8426 

8452 

8439 

8445 

8451 

1 

1 

2 

3 

3 

7.0 

0.8451 

8457 

8463 

8470 

8476 

8482 

8488 

8494 

8500 

8506 

8513 

1 

1 

2 

2 

3 

7.1 

8513 

8519 

8525 

8531 

8537 

8543 

8549 

8555 

8561 

8567 

8573 

1 

1 

2 

2 

3 

7.2 

8573 

8579 

8585 

8591 

8597 

8603 

8609 

8615 

8621 

8627 

8633 

1 

1 

2 

2 

3 

7.3 

8633 

8639 

8645 

8651 

8657 

8663 

8669 

8675 

8681 

8686 

8692 

1 

1 

2 

2 

3 

7.4 

8692 

8698 

8704 

8710 

8716 

8722 

8727 

8733 

8739 

8745 

8751 

1 

1 

2 

2 

3 

7.5 

8751 

8756 

8762 

8768 

8774 

8779 

8785 

8791 

8797 

8802 

8808 

1 

1 

2 

2 

3 

7.6 

8808 

8814 

8820 

8825 

8831 

8837 

8842 

8848 

8854 

8859 

8865 

1 

1 

2 

2 

3 

7.7 

8865 

8871 

8876 

8882 

8887 

8893 

8899 

8904 

8910 

8915 

8921 

1 

1 

2 

2 

3 

7.8 

8921 

8927 

8932 

8938 

8943 

8949 

8954 

8960 

8965 

8971 

8976 

1 

1 

2 

2 

3 

7.9 

8976 

8982 

8987 

8993 

8998 

9004 

9009 

9015 

9020 

9025 

9031 

1 

1 

2 

2 

3 

8.0 

0.9031 

9036 

9042 

9047 

9053 

9058 

9063 

9069 

9074 

9079 

9085 

1 

1 

2 

2 

3 

8.1 

9085 

9090 

9096 

9101 

9106 

9112 

9117 

9122 

9128 

9133 

9138 

1 

1 

2 

2 

3 

8.2 

9138 

9143 

9149 

9154 

9159 

9165 

9170 

9175 

9180 

9186 

9191 

1 

1 

2 

2 

3 

8.3 

9191 

9196 

9201 

9206 

9212 

9217 

9222 

9227 

9232 

9238 

9243 

1 

1 

2 

2 

3 

8.4 

9243 

9248 

9253 

9258 

9263 

9269 

9274 

9279 

9284 

9289 

9294 

1 

1 

2 

2 

3 

8.5 

9294 

9299 

9304 

9309 

9315 

9320 

9325 

9330 

9335 

9340 

9345 

1 

1 

2 

2 

3 

8.6 

9345 

9350 

9355 

9360 

9365 

9370 

9375 

9380 

9385 

9390 

9395 

1 

1 

2 

Z 

3 

8.7 

9395 

9400 

9405 

9410 

9415 

9420 

9425 

9430 

9435 

9440 

9445 

0 

1 

1 

2 

2 

8.8 

9445 

9450 

9455 

9460 

9465 

9469 

9474 

9479 

9484 

9489 

9494 

0 

1 

1 

2 

2 

8.9 

9494 

9499 

9504 

9509 

9513 

9518 

9523 

9528 

9533 

9538 

9542 

0 

1 

1 

2 

2 

9.0 

0.9542 

9547 

9552 

9557 

9562 

9566 

9571 

9576 

9581 

9586 

9590 

0 

1 

1 

2 

2 

9.1 

9590 

9595 

9600 

9605 

9609 

9614 

9619 

9624 

9628 

9633 

9638 

0 

1 

1 

2 

2 

9.2 

9638 

9643 

9647 

9652 

9657 

9661 

9666 

9671 

9675 

9680 

9685 

0 

1 

1 

2 

2 

9.3 

9685 

9689 

9694 

9699 

9703 

9708 

9713 

9717 

9722 

9727 

9731 

0 

1 

1 

2 

2 

9.4 

9731 

9736 

9741 

9745 

9750 

9754 

9759 

9763 

9768 

9773 

9777 

0 

1 

1 

2 

2 

9.b 

9777 

9782 

9786 

9791 

9795 

9800 

9805 

9809 

9814 

9818 

9823 

0 

1 

1 

2 

2 

9.6 

9823 

9827 

9832 

•9836 

9841 

9845 

9850 

9854 

9859 

9863 

9868 

0 

1 

1 

2 

2 

9.7 

9868 

9872 

9871 

9881 

9886 

9890 

9894 

9899 

9903 

9908 

9912 

0 

1 

1 

2 

2 

9.8 

9912 

9917 

9921 

9926 

9930 

9934 

9939 

9943 

9948 

9952 

9956 

0 

1 

1 

2 

2 

8.9 

9956 

9961 

9965 

9969 

9974 

9978 

9983 

9987 

9991 

9996 

0 

1 

1 

2 

2 

INDEX 


ABSORPTION,  carbon  dioxid,  potash  solu-    Basal   metabolic   rate,    calculation    of, 


tion  for,  81 
Air,  expired,  collection  of,  in  gasometer, 

50 
outdoor,  41 

analysis,  Form  4,  facing  page  112 
analysis  of,  with  Haldane  gas  an- 
alysis apparatus,  79 
room,  41 

stratification  of,  in  gasometer,  53 
Allen  and  Du  Bois,  88,  89 
Analysis,  outdoor  air,  Form  4,  facing 

p.  112 

Appendix,  94 
Atwater,  12 

At  water  and  Benedict,  12,  20,  89 
Atwater  and  Rosa,  12,  89 
Aub  and  Du  Bois,  89,  107 
Aub  and  Means,  92 


BAROMETER,  49,  95 
Barr  and  Du  Bois,  29,  89 
Barr,  Olmstead,  and  Du  Bois,  92 
Barr,  Soderstrom,  and  Du  Bois,  24,  93 
Basal  metabolic  rate,  body  position,  31 
calculation  of,  82 

calories  per  square  meter  per 

hour,  86 

carbon  dioxid  production,  84 
checking  calculations,  86 
correction  for  water  vapor,  83 


of  barometer  to  0°  C.,  83 

in  diabetes,  88 

non-protein    respiratory    quo- 
tient, 87 

oxygen  absorption,  84 

reduction  to  standard  pressure, 

83 
temperature,  83 

respiratory-  quotient,  30,  85 

8  113 


ventilation  rate,  84 
volume  of  expired  air,  82 
character  of  respiration,  30 
definition,  11 
effect  of  body  temperature,  29 

of  sleep,  30 
gasometer,  42 

and  accessory  apparatus,  35 
general  discussion,  11 
Haldane  gas  analysis  apparatus, 

56 

influence  of  food  on,  24 
laboratory  errors,   detection    of, 

34,  86 

muscular  activity,  24 
normal  standards,  14,  107 
observer's  chart,  32 

Form  1,  facing  p.  112 
postabsorptive  condition,  24 
prediction  of,  from  unit  of  sur- 
face area,  14 

preliminary  rest  period,  25 
repetition  of  test,  34 
technic,  details  of,  24 
Bell,  gasometer,  47,  49 
Benedict,  13,  14,  16,  17,  21,  24,  78,  79, 

89,  90 

Benedict  and  Atwater,  12,  20,  89 
Benedict  and  Carpenter,  24,  25,  30,  90 
Benedict  and  Cathcart.  90 
Benedict  and  Emmes,  90 
Benedict  and  Harris,  15,  91 

on   prediction   of   basal   metabolic 

rate,  15 

Benedict  and  Joslin,  31,  90 
Benedict  and  Murschhausen,  90 
Benedict  and  Roth,  90 
Benedict  and  Smith,  90 
Benedict  and  Talbot,  90 
Benedict  and  Tompkins,  21,  91 


114 


INDEX 


Benedict,  Emmes,  Roth,  and  Smith,  90 
Benedict,  Miles,  Roth,  and  Smith,  90 
Benedict's  unit  apparatus  for  indirect 

calorimetry,  20 
portable,  21 
Bibliography,  89-93 
Black  rubber  grease,  81 
Body  position,  31 

temperature,  effect  of,  29 
Boothby,  14,  29,  30,  91 
Boothby  and  Sandiford,  17 
Bornstein,  Landolt,  and  Roth,  92,  95 
Boyle's  law,  83 
Buret,  Haldane,  calibration  of,  60 


CALCULATION  of  basal  metabolic  rate,  82 
calories  per  square  meter  per 

hour,  86 

carbon  dioxid  production,  84 
checking  calculations,  86 
correction  for  water  vapor,  83 

of  barometer  to  0°  C.,  83 
non-protein    respiratory    quo- 
tient, 87 
of  diabetic,  88 
oxygen  absorption,  84 
reduction  to  standard  pressure, 

83 

temperature,  83 
respiratory  quotient,  85 

sheet,  Form  2,  facing  p.  112 
ventilation  rate,  84 
volume  of  expired  air,  82 
Calibration  of  gasometer,  49 

of  Haldane  buret,  60 
Calorimeter,  respiration,  18 

definition  of,  18 
Calorimetry,  clinical,  17 
direct,  18 
and  indirect,  agreement  between, 

20 

indirect,  18,  20 

and  direct,  agreement  between,  20 
closed-circuit  type  of  apparatus,  20 
gasometer  method,  22 
portable  unit  apparatus,  21 
Tissot's  gasometer  method,  22 


Calorimetry,  indirect,  unit  apparatus,  20 
Carbon  dioxid  absorption,  potash  solu- 
tion for,  81 
of    expired    air,    effect    on,    from 

standing  in  gasometer,  55 
Card,  summary,  Form  3,  facing  p.  112 
Carnegie  Institute,  12,  13 
Carnegie  Nutrition  Laboratory,  13 
Carpenter,  20,  21,  37,  38,  42,  53,  91 
Carpenter  and  Benedict,  24,  25,  30,  90 
Carpenter,  Hendry,  and  Emmes,  35,  91 
Cathcart  and  Benedict,  90 
Charles'  law,  83 
Chart,  Du  Bois  height-weight,  10*6 

observer's,  32 

Form  1,  facing  p.  112 
Chauveau,  42 
Cleaning  mercury,  81 

solution,  81 

Clinical  calorimetry,  17 
Coleman  and  Du  Bois,  29,  91 
Connections,  42 
Control  tube  of  Haldane  gas  analysis 

apparatus,  68 
Gushing,  17 
Czerny,  93 


DAPPER,  93 

Denis  and  Means,  91 

Dennis,  91 

Diabetes,  calculation  of  basal  metabolic 
rate  in,  88 

Douglas  and  Haldane,  30,  91 

Douglas  valves,  38 

Du  Bois,  13,  14,  15,  17,  25,  86,  91,  106, 
107 

Du  Bois  and  Allen,  88,  89 

Du  Bois  and  Aub,  89 

Du  Bois  and  Barr,  29,  89 

Du  Bois  and  Coleman,  29,  91 

Du  Bois  and  Du  Bois,  14,  16,  91 

Du  Bois  and  Du  Bois'  formula  for  de- 
termination of  surface  area,  14,  106 

Du  Bois  and  Gephart,  20,  91 

Du  Bois  and  Lusk,  13,  20 

Du  Bois  height-weight  chart,  106 

Du  Bois,  Meyer,  and  Soderstrom,  31,  93 


INDEX 


Du  Bois,  Olmstead,  and  Barr,  92 
Du  Bois,  Sawyer,  and  Stone,  93 
Du  Bois,  Soderstrom,  and  Barr,  24,  93 
Du  Bois,  Soderstrom,  and  Meyer,  31 


EDSALL,  17 

Electric  glass  cutter,  66 

Emmes  and  Benedict,  90 

Emmesand  Riche,  31,  91 

Emmes,  Benedict,  Roth,  and  Smith,  90 

Emmes,  Hendry,  and  Carpenter,  35,  91 

Expired  air,  collection  of,  in  gasometer, 

50 
Explanation  of  tables,  94 


FILLING    Haldane    gas   analysis   appa- 
ratus, 77 
Food,  influence  of,  on  basal  metabolic 

rate,  24 
Formula,  Du  Bois  and  Du  Bois',  for 

determination  of  surface  area,  14 
Meeh's,  for  determination  of  surface 
area,  14 


GEPHART  and  Du  Bois,  20,  91 
Gas  analysis  apparatus,  Haldane,  56 
analysis  of  outdoor  air,  78 

of  room  air,  41 
assembling,  65 
care,  73 

control  tube,  68 
description  of,  56 
filling,  77 
management,  69 
analysis,  72 
preliminary,  69 
sampling,  70 
shaker,  79 
Gasometer,  42 

and  accessory  apparatus,  35 
bell,  47 

calibration  of,  49 
collection  of  expired  air  in,  50 
construction  of,  47 
cross-section  of,  43 


Gasometer,  effect  on  carbon  dioxid  of 
expired  air  from  standing  in,  55 
on  oxygen  content  of  expired  air 

from  standing  in,  55 
method  of  indirect  calorimetry,  22 
movable,  46 
room,  45 
stationary,  44 
stratification  of  air  in,  53 
Glass  cutter,  electric,  66 
Grease,  black  rubber,  81 


HALDANE,  56,  63,  65,  74,  78,  80,  91 
Haldane  and  Douglas,  30,  91 
Haldane  buret,  calibration  of,  60 
gas  analysis  apparatus,  56 

analysis  of  outdoor  air,  78 
assembling,  65 
care,  73 

control  tube,  68 
description,  56 
filling,  77 
management,  69 
analysis,  72 
preliminary,  69 
sampling,  70 
shaker,  79 

potassium  pyrogallate  solution,  80 
Harris  and  Benedict,  15,  91 

on   prediction   of   basal   metabolic 

rate,  15 

Height-weight  chart,  Du  Bois,  106 
Hendry,  Carpenter,  and  Emmes,  35,  91 
Higgins  and  Means,  91 
Howland,  20,  91 
Huntington,  92 


INTAKE  pipe,  41 


JOHANSSON,  31,  92 

Joslin  and  Benedict,  31,  90 

KRAUS,  93 

Krogh,  20,  92 

Krogh  and  Lindhard,  52,  92 


n6 


INDEX 


LABORATORY  errors,  detection  of,  34,  86 
Landolt,  Bornstein,  and  Roth,  92,  95 
Laplace  and  Lavoisier,  92 
Lavoisier,  11,  24 

on  physiologic  importance  of  oxygen, 

11 

Lavoisier  and  Laplace,  92 
Lavoisier  and  Seguin,  92 
Law,  Boyle's,  83 

Charles',  83 

Lindhard  and  Krogh,  52,  92 
Little,  45 
Loewi,  93 

Lusk,  13,  20,  24,  29,  89,  92 
Lusk  and  Du  Bois,  13,  20 
Lusk  and  Williams,  13 
Lusk,  Williams,  and  Riche,  93 


MAGNUS-LEVY,  87,  92,  93 

Mask,  35 

Matthes,  93 

Means,  14,  17,  92 

Means  and  Aub,  92 

Means  and  Denis,  91 

Means  and  Higgins,  91 

Meeh,  14,  92 

Meeh's   formula   for   determination   of 

surface  area,  14 
Mercury,  cleaning,  81 
Metabolic    rate,    basal,    11.      See    also 

Basal  metabolic  rate. 
Meyer,  Du  Bois,  and  Soderstrom,  31 
Meyer,  Soderstrom,  and  Du  Bois,  93 
Miles,  Benedict,  Roth,  and  Smith,  90 
Mohr,  93 

Movable  gasometer,  46 
Murschhausen  and  Benedict,  90 
Muscular  activity,  24 


NEUBERG,  93 


OBSERVER'S  chart,  32 

Form  1,  facing  p.  112 
Olmstead,  Barr,  and  Du  Bois,  92 
Outdoor  air,  41 


Outdoor  air  analysis,  Form  4,  facing  p. 

112 
Oxygen  content  of  expired  air,  effect  on, 

from  standing  in  gasometer,  55 


PETTENKOFER,  12,  92 
Pettenkofer  and  Voit,  12,  92 
Pipe,  intake,  41 
Plummer,  18 
Position,  body,  31 
Postabsorptive  condition,  24 
Potash  solution  for  carbon  dioxid  ab- 
sorption, 81 
Potassium  pyrogallate  solution,  80 


REGNAULT  and  Reiset,  11,  92 

Reiset  and  Regnault,  11,  92 

Repetition  of  test,  34 

Respiration  calorimeter,  18 

definition,  18 
character  of,  30 

Respiratory  exchange,  Tissot's  gasom- 
eter method  of  determining,  42 

Rest  period,  preliminary,  25 

Riche  and  Emmes,  91 

Riche  and  Soderstrom,  93 

Riche,  Williams,  and  Lusk,  93 

Rinsing  connections,  69 

Room  air,  41 
gasometer,  45 

Rosa  and  At  water,  12,  89 

Roth  and  Benedict,  90 

Roth,  Benedict,  Emmes  and  Smith,  90 

Roth,  Benedict,  Miles  and  Smith,  90 

Roth,  Landolt,  a^nd  Bornstein,  92,  95 

Rubber  flutter  valve,  39 

Rubner,  12,  14,  20,  93 

Russell  and  Williamson,  68,  93 

Russell  Sage  Institute  of  Pathology,  13 


SALOMON,  93 
Sampling  tubes,  52 
Sandiford  and  Boothby,  17 
Sawyer,  Stone,  and  Du  Bois,  93 
Schmidt,  93 


INDEX 


117 


Schumburg  and  Zuntz,  93,  104 

Seguin  and  Lavoisier,  92 

Shaker,  79 

Sheet,  calculation,  Form  2,  facing  p.  112 

Sleep,  effect  of,  30 

Smith  and  Benedict,  90 

Smith,  Benedict,  Emmes,  and  Roth,  90 

Smith,  Benedict,  Miles  and  Roth,  90 

Soderstrom  and  Riche,  93 

Soderstrom,  Barr,  and  Du  Bois,  24,  93 

Soderstrom,  Meyer,  and  Du  Bois,  31,  93 

Solution,  cleaning,  81 

potash,  for  carbon  dioxid  absorption, 
81 

potassium  pyrogallate  (Haldane),  80 
Solutions,  80 

Standards,  normal,  14,  107 
Steinitz,  93 

Stone,  Sawyer,  and  Du  Bois,  93 
Stratification  of  air  in  gasometer,  53 
Strauss,  93 
Summary  card,  Form  3,  facing  p.  112 


TABLE  I,  explanation  of,  94 
Table  II,  explanation  of,  94-103 
Table  III,  explanation  of,  103,  104 
Table  IV,  explanation  of,  104,  105 
Table  V,  explanation  of,  106 
Table  VI,  explanation  of,  107 
Table  VII,  explanation  of,  107-111 
Tables,  explanation  of,  94 
Talbot  and  Benedict,  90 
Temperature,  body,  effect  of,  29 


Test,  repetition  of,  34 
Tissot,  17,  22,  42,  93 
Tissot's    gasometer    method    of    deter- 
mining respiratory  change,  42 
of  indirect  calorimetry,  22 
Tompkins  and  Benedict,  21,  91 
Tube,  control,  of  Haldane  gas  analysis 

apparatus,  68 
Tubes,  sampling,  52 


UNIT   apparatus    for  indirect  calorim- 
etry, 20 

portable,  for  indirect  calorimetry, 
21 


VALVE,  rubber  flutter,  39 
Valves,  37 

Douglas,  38 
Voit,  12 

Voit  and  Pettenkofer,  12,  92 
Von  Noorden,  93 


WASHING  connections,  69 
Weintraud,  93 
Williams,  93 
Williams  and  Lusk,  13 
Williams,   Riche,  and  Lusk,  93 
Williamson  and  Russell,  68,  93 


ZUNTZ  and  Schumburg,  93,  104 


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